- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.52 / $62.72 / $135.22
| Facility | 26 | $26.52 | $62.72 | $135.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.28 / $220.05 / $508.17
| Professional | | $169.28 | $220.05 | $508.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.02 / $259.95 / $512.26
| Professional | | $171.02 | $259.95 | $512.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.69 / $310.00 / $571.84
| Professional | | $181.69 | $310.00 | $571.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.13 / $387.60 / $578.33
| Professional | | $243.13 | $387.60 | $578.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.58 / $51.94 / $89.42
| Professional | 26 | $32.58 | $51.94 | $89.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.10 / $267.51 / $795.00
| Professional | | $44.10 | $267.51 | $795.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.81 / $278.41 / $568.13
| Professional | | $176.81 | $278.41 | $568.13 |