- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.45 / $51.47 / $84.68
| Facility | 26 | $32.45 | $51.47 | $84.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.18 / $280.00 / $926.96
| Professional | | $249.18 | $280.00 | $926.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.00 / $361.74 / $549.85
| Professional | | $269.00 | $361.74 | $549.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.64 / $408.29 / $639.22
| Professional | | $201.64 | $408.29 | $639.22 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.61 / $180.12 / $180.12
| Facility | 26 | $87.61 | $180.12 | $180.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.94 / $397.95 / $1,900.36
| Professional | | $273.94 | $397.95 | $1,900.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.94 / $393.51 / $659.04
| Professional | | $273.94 | $393.51 | $659.04 |