- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $134.90 / $162.18
| Facility | 26 | $85.11 | $134.90 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $151.36 / $288.40
| Professional | | $131.83 | $151.36 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $91.20 / $181.97
| Professional | 26 | $75.86 | $91.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Professional | | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $85.11 / $177.83
| Professional | 26 | $74.13 | $85.11 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $489.78 / $870.96
| Professional | | $194.98 | $489.78 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.33 / $112.20 / $177.83
| Professional | 26 | $93.33 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $275.42 / $891.25
| Professional | | $131.83 | $275.42 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $120.23 / $199.53
| Professional | 26 | $79.43 | $120.23 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $223.87 / $645.65
| Professional | | $154.88 | $223.87 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $100.00 / $162.18
| Professional | 26 | $85.11 | $100.00 | $162.18 |