- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $181.97 / $181.97 / $218.78
| Facility | 26 | $181.97 | $181.97 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $467.74 / $891.25
| Professional | | $288.40 | $467.74 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $309.03 / $501.19
| Professional | | $281.84 | $309.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $467.74 / $724.44
| Professional | | $269.15 | $467.74 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.27 / $346.74 / $467.74
| Professional | | $4.27 | $346.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $1.00 / $128.82 / $169.82
| Professional | 26 | $1.00 | $128.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.27 / $4.27 / $416.87
| Professional | | $4.27 | $4.27 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $281.84 / $281.84
| Professional | | $269.15 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $389.05 / $645.65
| Professional | | $263.03 | $389.05 | $645.65 |