- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.42 / $74.45 / $152.37
| Facility | 26 | $63.42 | $74.45 | $152.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.49 / $338.80 / $349.00
| Professional | | $213.49 | $338.80 | $349.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.46 / $54.26 / $64.03
| Professional | 26 | $52.46 | $54.26 | $64.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.48 / $384.98 / $492.17
| Professional | | $249.48 | $384.98 | $492.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.89 / $62.79 / $105.20
| Professional | 26 | $41.89 | $62.79 | $105.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.40 / $57.40 / $57.40
| Professional | 26 | $57.40 | $57.40 | $57.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.42 / $366.89 / $632.48
| Professional | | $222.42 | $366.89 | $632.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.91 / $68.68 / $136.46
| Professional | 26 | $46.91 | $68.68 | $136.46 |