- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.98 / $66.98 / $66.98
| Facility | 26 | $66.98 | $66.98 | $66.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.11 / $355.59 / $463.93
| Professional | | $309.11 | $355.59 | $463.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.82 / $56.89 / $114.77
| Professional | 26 | $50.82 | $56.89 | $114.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.83 / $349.21 / $615.71
| Professional | | $296.83 | $349.21 | $615.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.53 / $55.05 / $59.57
| Professional | 26 | $38.53 | $55.05 | $59.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.11 / $474.32 / $804.94
| Professional | | $361.11 | $474.32 | $804.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.90 / $69.81 / $124.66
| Professional | 26 | $57.90 | $69.81 | $124.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.05 / $350.56 / $560.90
| Professional | | $210.05 | $350.56 | $560.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.35 / $64.80 / $97.62
| Professional | 26 | $55.35 | $64.80 | $97.62 |