- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $97.74 / $97.74 / $178.93
| Facility | 26 | $97.74 | $97.74 | $178.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.14 / $276.14 / $537.55
| Professional | | $276.14 | $276.14 | $537.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.79 / $57.80 / $137.31
| Professional | 26 | $55.79 | $57.80 | $137.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.57 / $494.57 / $494.57
| Professional | | $494.57 | $494.57 | $494.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.33 / $74.75 / $105.66
| Professional | 26 | $52.33 | $74.75 | $105.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.95 / $470.61 / $939.54
| Professional | | $195.95 | $470.61 | $939.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.86 / $104.06 / $133.07
| Professional | 26 | $39.86 | $104.06 | $133.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.13 / $411.88 / $738.54
| Professional | | $116.13 | $411.88 | $738.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.64 / $90.21 / $122.08
| Professional | 26 | $38.64 | $90.21 | $122.08 |