- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $384.50 / $384.50 / $534.96
| Facility | 26 | $384.50 | $384.50 | $534.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.75 / $354.90 / $413.97
| Professional | | $214.75 | $354.90 | $413.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.93 / $57.89 / $67.27
| Professional | 26 | $46.93 | $57.89 | $67.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.39 / $289.87 / $628.89
| Professional | | $246.39 | $289.87 | $628.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.77 / $85.38 / $118.48
| Professional | 26 | $59.77 | $85.38 | $118.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.93 / $425.00 / $563.35
| Professional | | $215.93 | $425.00 | $563.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.20 / $121.06 / $128.66
| Professional | 26 | $55.20 | $121.06 | $128.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.57 / $354.26 / $472.04
| Professional | | $243.57 | $354.26 | $472.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.62 / $73.22 / $127.34
| Professional | 26 | $56.62 | $73.22 | $127.34 |