- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $99.62 / $99.62 / $99.62
| Facility | 26 | $99.62 | $99.62 | $99.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.49 / $574.10 / $574.10
| Professional | | $312.49 | $574.10 | $574.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.95 / $469.09 / $667.99
| Professional | | $322.95 | $469.09 | $667.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.17 / $456.24 / $653.64
| Professional | | $430.17 | $456.24 | $653.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $464.57
| Professional | | $32.34 | $32.34 | $464.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $949.44 / $949.44 / $949.44
| Facility | 26 | $949.44 | $949.44 | $949.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.94 / $565.80 / $653.63
| Professional | | $535.94 | $565.80 | $653.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.91 / $330.60 / $591.60
| Professional | | $256.91 | $330.60 | $591.60 |