- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.86 / $85.58 / $172.38
| Facility | 26 | $33.86 | $85.58 | $172.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.06 / $249.82 / $793.95
| Professional | | $222.06 | $249.82 | $793.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.31 / $353.28 / $642.79
| Professional | | $260.31 | $353.28 | $642.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.22 / $520.66 / $791.53
| Professional | | $306.22 | $520.66 | $791.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.33 / $456.48 / $3,449.00
| Professional | | $286.33 | $456.48 | $3,449.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.67 / $64.83 / $448.37
| Professional | 26 | $40.67 | $64.83 | $448.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.39 / $337.24 / $398.65
| Professional | | $55.39 | $337.24 | $398.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.95 / $395.66 / $687.46
| Professional | | $296.95 | $395.66 | $687.46 |