- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.00 / $64.00 / $142.99
| Facility | 26 | $60.00 | $64.00 | $142.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.51 / $300.00 / $512.50
| Professional | | $271.51 | $300.00 | $512.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.00 / $70.23 / $174.88
| Professional | 26 | $60.00 | $70.23 | $174.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.27 / $81.04 / $93.20
| Professional | 26 | $62.27 | $81.04 | $93.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.85 / $425.17 / $600.49
| Professional | | $348.85 | $425.17 | $600.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $99.32 / $137.53 / $163.74
| Professional | 26 | $99.32 | $137.53 | $163.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.40 / $77.40 / $81.53
| Professional | 26 | $77.40 | $77.40 | $81.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.73 / $334.22 / $641.04
| Professional | | $185.73 | $334.22 | $641.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.57 / $95.27 / $170.83
| Professional | 26 | $55.57 | $95.27 | $170.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.24 / $377.00 / $641.78
| Professional | | $257.24 | $377.00 | $641.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.75 / $96.38 / $154.69
| Professional | 26 | $71.75 | $96.38 | $154.69 |