- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.90 / $125.99 / $244.61
| Facility | 26 | $26.90 | $125.99 | $244.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.73 / $229.32 / $386.04
| Professional | | $209.73 | $229.32 | $386.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.44 / $271.89 / $686.53
| Professional | | $249.44 | $271.89 | $686.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.69 / $277.95 / $1,185.00
| Professional | | $208.69 | $277.95 | $1,185.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.83 / $556.15 / $556.15
| Professional | | $247.83 | $556.15 | $556.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.64 / $67.44 / $67.44
| Professional | 26 | $30.64 | $67.44 | $67.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.18 / $386.72 / $831.94
| Professional | | $150.18 | $386.72 | $831.94 |