- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.75 / $218.28 / $236.24
| Facility | 26 | $46.75 | $218.28 | $236.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.88 / $206.46 / $590.19
| Professional | | $169.88 | $206.46 | $590.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.60 / $279.67 / $583.89
| Professional | | $207.60 | $279.67 | $583.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.00 / $385.18 / $648.69
| Professional | | $231.00 | $385.18 | $648.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.26 / $426.05 / $1,930.00
| Professional | | $267.26 | $426.05 | $1,930.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.54 / $94.92 / $458.64
| Professional | 26 | $59.54 | $94.92 | $458.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.64 / $285.13 / $449.48
| Professional | | $79.64 | $285.13 | $449.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.02 / $293.12 / $612.23
| Professional | | $221.02 | $293.12 | $612.23 |