- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.91 / $92.07 / $245.18
| Facility | 26 | $47.91 | $92.07 | $245.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.79 / $320.67 / $928.95
| Professional | | $262.79 | $320.67 | $928.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.44 / $370.76 / $740.65
| Professional | | $238.44 | $370.76 | $740.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.21 / $510.55 / $630.74
| Professional | | $120.21 | $510.55 | $630.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.33 / $468.48 / $871.82
| Professional | | $286.33 | $468.48 | $871.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.95 / $521.44 / $803.89
| Professional | | $337.95 | $521.44 | $803.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.54 / $93.33 / $139.26
| Professional | 26 | $58.54 | $93.33 | $139.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.23 / $391.06 / $1,081.33
| Professional | | $79.23 | $391.06 | $1,081.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.75 / $413.49 / $739.00
| Professional | | $259.75 | $413.49 | $739.00 |