- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $126.49 / $126.49 / $212.92
| Facility | 26 | $126.49 | $126.49 | $212.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.46 / $435.72 / $733.46
| Professional | | $359.46 | $435.72 | $733.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.00 / $638.00 / $638.00
| Professional | | $638.00 | $638.00 | $638.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.08 / $472.35 / $766.39
| Professional | | $317.08 | $472.35 | $766.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $295.58
| Professional | | $32.34 | $32.34 | $295.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.70 / $388.03 / $695.30
| Professional | | $298.70 | $388.03 | $695.30 |