- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $86.36 / $95.36 / $113.94
| Facility | 26 | $86.36 | $95.36 | $113.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.34 / $344.51 / $443.74
| Professional | | $247.34 | $344.51 | $443.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.53 / $71.40 / $104.89
| Professional | 26 | $44.53 | $71.40 | $104.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.74 / $435.58 / $558.44
| Professional | | $379.74 | $435.58 | $558.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.86 / $85.87 / $110.09
| Professional | 26 | $74.86 | $85.87 | $110.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.67 / $430.01 / $643.04
| Professional | | $287.67 | $430.01 | $643.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.98 / $91.88 / $127.85
| Professional | 26 | $66.98 | $91.88 | $127.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.57 / $357.46 / $615.16
| Professional | | $256.57 | $357.46 | $615.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.60 / $71.73 / $125.25
| Professional | 26 | $60.60 | $71.73 | $125.25 |