- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $68.78 / $122.33 / $130.22
| Facility | 26 | $68.78 | $122.33 | $130.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.98 / $358.78 / $484.67
| Professional | | $255.98 | $358.78 | $484.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.46 / $98.00 / $130.22
| Professional | 26 | $52.46 | $98.00 | $130.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.98 / $52.56 / $102.39
| Professional | 26 | $41.98 | $52.56 | $102.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.00 / $494.00 / $494.00
| Professional | | $494.00 | $494.00 | $494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.58 / $449.03 / $662.41
| Professional | | $208.58 | $449.03 | $662.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.80 / $94.23 / $120.19
| Professional | 26 | $48.80 | $94.23 | $120.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $190.84
| Professional | | $32.34 | $32.34 | $190.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.24 / $302.27 / $640.09
| Professional | | $234.24 | $302.27 | $640.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.96 / $69.00 / $118.12
| Professional | 26 | $49.96 | $69.00 | $118.12 |