- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.19 / $105.65 / $234.76
| Facility | 26 | $46.19 | $105.65 | $234.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.25 / $154.68 / $405.59
| Professional | | $98.25 | $154.68 | $405.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.59 / $213.99 / $719.53
| Professional | | $114.59 | $213.99 | $719.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $61.14 / $61.14 / $61.14
| Facility | 26 | $61.14 | $61.14 | $61.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.22 / $292.82 / $817.00
| Professional | | $121.22 | $292.82 | $817.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.64 / $228.44 / $1,275.77
| Professional | | $125.64 | $228.44 | $1,275.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.78 / $90.52 / $219.63
| Professional | 26 | $56.78 | $90.52 | $219.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.10 / $102.67 / $191.77
| Professional | | $62.10 | $102.67 | $191.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.51 / $215.48 / $523.94
| Professional | | $126.51 | $215.48 | $523.94 |