- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $97.34 / $112.23 / $126.97
| Facility | 26 | $97.34 | $112.23 | $126.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.74 / $188.48 / $244.46
| Professional | | $118.74 | $188.48 | $244.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.34 / $78.95 / $113.39
| Professional | 26 | $51.34 | $78.95 | $113.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.39 / $224.19 / $249.10
| Professional | | $169.39 | $224.19 | $249.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.40 / $106.41 / $118.23
| Professional | 26 | $80.40 | $106.41 | $118.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.07 / $224.99 / $321.83
| Professional | | $142.07 | $224.99 | $321.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.86 / $103.12 / $148.24
| Professional | 26 | $64.86 | $103.12 | $148.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.65 / $193.10 / $303.54
| Professional | | $155.65 | $193.10 | $303.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.11 / $91.32 / $143.55
| Professional | 26 | $72.11 | $91.32 | $143.55 |