- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $66.07 / $77.62
| Facility | 26 | $66.07 | $66.07 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $263.03 / $602.56
| Professional | | $190.55 | $263.03 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $64.57 / $134.90
| Professional | 26 | $51.29 | $64.57 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $363.08 / $549.54
| Professional | | $199.53 | $363.08 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $70.79 / $112.20
| Professional | 26 | $42.66 | $70.79 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $309.03 / $588.84
| Professional | | $173.78 | $309.03 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $66.07 / $131.83
| Professional | 26 | $43.65 | $66.07 | $131.83 |