- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.29 / $66.29 / $121.20
| Facility | 26 | $66.29 | $66.29 | $121.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.87 / $258.44 / $597.04
| Professional | | $205.87 | $258.44 | $597.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.75 / $62.17 / $106.06
| Professional | 26 | $46.75 | $62.17 | $106.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.02 / $291.20 / $323.56
| Professional | | $220.02 | $291.20 | $323.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.18 / $74.36 / $82.62
| Professional | 26 | $56.18 | $74.36 | $82.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.70 / $273.64 / $338.18
| Professional | | $202.70 | $273.64 | $338.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.34 / $68.16 / $86.35
| Professional | 26 | $50.34 | $68.16 | $86.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.16 / $242.16 / $429.28
| Professional | | $169.16 | $242.16 | $429.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.87 / $55.58 / $98.81
| Professional | 26 | $44.87 | $55.58 | $98.81 |