- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.33 / $114.82 / $120.23
| Facility | 26 | $93.33 | $114.82 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $524.81 / $616.60
| Professional | | $251.19 | $524.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $89.13 / $123.03
| Professional | 26 | $61.66 | $89.13 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $512.86 / $660.69
| Professional | | $446.68 | $512.86 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $87.10 / $109.65
| Professional | 26 | $75.86 | $87.10 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $602.56 / $812.83
| Professional | | $389.05 | $602.56 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $100.00 / $141.25
| Professional | 26 | $79.43 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $467.74 / $758.58
| Professional | | $380.19 | $467.74 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $75.86 / $134.90
| Professional | 26 | $67.61 | $75.86 | $134.90 |