- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.93 / $45.08 / $45.08
| Facility | 26 | $42.93 | $45.08 | $45.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.43 / $225.73 / $360.00
| Professional | | $203.43 | $225.73 | $360.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.21 / $315.58 / $460.90
| Professional | | $233.21 | $315.58 | $460.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.50 / $311.31 / $526.17
| Professional | | $200.50 | $311.31 | $526.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.73 / $397.73 / $426.61
| Professional | | $397.73 | $397.73 | $426.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.99 / $339.68 / $424.21
| Professional | | $214.99 | $339.68 | $424.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.93 / $67.83 / $83.71
| Professional | 26 | $42.93 | $67.83 | $83.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.50 / $384.58 / $677.51
| Professional | | $200.50 | $384.58 | $677.51 |