- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.15 / $78.31 / $173.86
| Facility | 26 | $34.15 | $78.31 | $173.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.08 / $289.41 / $814.55
| Professional | | $232.08 | $289.41 | $814.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.56 / $353.80 / $663.00
| Professional | | $243.56 | $353.80 | $663.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.37 / $483.33 / $764.62
| Professional | | $272.37 | $483.33 | $764.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.69 / $474.58 / $708.11
| Professional | | $297.69 | $474.58 | $708.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.03 / $65.41 / $133.72
| Professional | 26 | $41.03 | $65.41 | $133.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.40 / $316.16 / $968.95
| Professional | | $55.40 | $316.16 | $968.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.95 / $394.90 / $687.91
| Professional | | $276.95 | $394.90 | $687.91 |