- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $84.66 / $109.90 / $323.81
| Facility | 26 | $84.66 | $109.90 | $323.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.70 / $425.00 / $475.00
| Professional | | $282.70 | $425.00 | $475.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.16 / $126.00 / $140.00
| Professional | 26 | $85.16 | $126.00 | $140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.93 / $523.75 / $770.25
| Professional | | $278.93 | $523.75 | $770.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.20 / $96.83 / $153.60
| Professional | 26 | $61.20 | $96.83 | $153.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.48 / $604.79 / $748.18
| Professional | | $264.48 | $604.79 | $748.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.43 / $98.23 / $199.58
| Professional | 26 | $70.43 | $98.23 | $199.58 |