- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.59 / $141.86 / $322.97
| Facility | 26 | $79.59 | $141.86 | $322.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.79 / $389.25 / $1,261.00
| Professional | | $275.79 | $389.25 | $1,261.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.40 / $66.98 / $211.29
| Professional | 26 | $50.40 | $66.98 | $211.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.29 / $466.72 / $681.75
| Professional | | $280.29 | $466.72 | $681.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.80 / $71.69 / $104.72
| Professional | 26 | $48.80 | $71.69 | $104.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.16 / $474.32 / $1,047.08
| Professional | | $250.16 | $474.32 | $1,047.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.58 / $88.42 / $165.36
| Professional | 26 | $69.58 | $88.42 | $165.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.53 / $489.93 / $696.74
| Professional | | $402.53 | $489.93 | $696.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.25 / $73.98 / $113.84
| Professional | 26 | $63.25 | $73.98 | $113.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.51 / $87.51 / $87.51
| Professional | | $87.51 | $87.51 | $87.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.74 / $510.37 / $1,036.72
| Professional | | $301.74 | $510.37 | $1,036.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.27 / $87.57 / $167.19
| Professional | 26 | $53.27 | $87.57 | $167.19 |