- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $114.82 / $125.89
| Facility | 26 | $97.72 | $114.82 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $162.18 / $263.03
| Professional | | $128.82 | $162.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $70.79 / $158.49
| Professional | 26 | $57.54 | $70.79 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Professional | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $194.98 / $251.19
| Professional | | $169.82 | $194.98 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $91.20 / $117.49
| Professional | 26 | $81.28 | $91.20 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $223.87 / $323.59
| Professional | | $141.25 | $223.87 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $102.33 / $151.36
| Professional | 26 | $64.57 | $102.33 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $190.55 / $302.00
| Professional | | $151.36 | $190.55 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $87.10 / $141.25
| Professional | 26 | $70.79 | $87.10 | $141.25 |