- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $78.36 / $91.99 / $126.00
| Facility | 26 | $78.36 | $91.99 | $126.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.05 / $425.00 / $475.00
| Professional | | $423.05 | $425.00 | $475.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.51 / $126.00 / $140.00
| Professional | 26 | $73.51 | $126.00 | $140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.94 / $500.96 / $769.51
| Professional | | $330.94 | $500.96 | $769.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.15 / $78.29 / $122.08
| Professional | 26 | $54.15 | $78.29 | $122.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.52 / $491.43 / $1,042.34
| Professional | | $385.52 | $491.43 | $1,042.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.61 / $71.70 / $163.24
| Professional | 26 | $29.61 | $71.70 | $163.24 |