- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $84.81 / $92.03 / $110.43
| Facility | 26 | $84.81 | $92.03 | $110.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.24 / $113.33 / $134.19
| Professional | | $62.24 | $113.33 | $134.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.79 / $85.40 / $85.40
| Professional | 26 | $44.79 | $85.40 | $85.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.82 / $118.64 / $131.82
| Professional | | $102.82 | $118.64 | $131.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.20 / $89.09 / $98.99
| Professional | 26 | $77.20 | $89.09 | $98.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.45 / $142.37 / $539.00
| Professional | | $93.45 | $142.37 | $539.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.06 / $102.36 / $132.56
| Professional | 26 | $71.06 | $102.36 | $132.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.75 / $122.37 / $336.18
| Professional | | $85.75 | $122.37 | $336.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.69 / $77.47 / $124.25
| Professional | 26 | $62.69 | $77.47 | $124.25 |