- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.51 / $70.51 / $70.51
| Facility | 26 | $70.51 | $70.51 | $70.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.93 / $423.05 / $525.00
| Professional | | $396.93 | $423.05 | $525.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.02 / $73.51 / $155.65
| Professional | 26 | $70.02 | $73.51 | $155.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.20 / $79.20 / $79.20
| Professional | | $79.20 | $79.20 | $79.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $80.68 / $80.68 / $80.68
| Facility | 26 | $80.68 | $80.68 | $80.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.52 / $505.28 / $1,944.20
| Professional | | $306.52 | $505.28 | $1,944.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.27 / $92.42 / $327.42
| Professional | 26 | $53.27 | $92.42 | $327.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.42 / $372.63 / $875.01
| Professional | | $248.42 | $372.63 | $875.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.97 / $65.34 / $118.85
| Professional | 26 | $39.97 | $65.34 | $118.85 |