- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $78.77 / $190.55 / $238.18
| Facility | 26 | $78.77 | $190.55 | $238.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.87 / $148.03 / $612.00
| Professional | | $113.87 | $148.03 | $612.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.02 / $108.03 / $159.35
| Professional | | $81.02 | $108.03 | $159.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.23 / $96.31 / $140.24
| Professional | | $72.23 | $96.31 | $140.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | 26 | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.17 / $147.72 / $230.83
| Professional | | $100.17 | $147.72 | $230.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $132.41 / $251.32 / $251.32
| Facility | 26 | $132.41 | $251.32 | $251.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.28 / $133.38 / $759.56
| Professional | | $119.28 | $133.38 | $759.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.28 / $127.68 / $232.24
| Professional | | $119.28 | $127.68 | $232.24 |