- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.23 / $90.12 / $116.99
| Facility | 26 | $87.23 | $90.12 | $116.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.33 / $173.43 / $534.57
| Professional | | $169.33 | $173.43 | $534.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.76 / $87.23 / $240.72
| Professional | 26 | $81.76 | $87.23 | $240.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.59 / $227.36 / $315.36
| Professional | | $139.59 | $227.36 | $315.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.33 / $98.34 / $162.44
| Professional | 26 | $64.33 | $98.34 | $162.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.35 / $550.35 / $550.35
| Professional | | $550.35 | $550.35 | $550.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.34 / $83.26 / $83.26
| Professional | 26 | $81.34 | $83.26 | $83.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.61 / $233.08 / $397.08
| Professional | | $152.61 | $233.08 | $397.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.50 / $111.20 / $211.39
| Professional | 26 | $74.50 | $111.20 | $211.39 |