- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $125.89 / $138.04
| Facility | 26 | $100.00 | $125.89 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $93.33 / $234.42
| Professional | | $75.86 | $93.33 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $74.13 / $74.13
| Professional | | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $93.33 / $162.18
| Professional | | $83.18 | $93.33 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.92 / $32.36 / $45.71
| Facility | 26 | $6.92 | $32.36 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $117.49 / $186.21
| Professional | | $77.62 | $117.49 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $125.89 / $125.89
| Facility | 26 | $66.07 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $107.15 / $602.56
| Professional | | $89.13 | $107.15 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $97.72 / $151.36
| Professional | | $87.10 | $97.72 | $151.36 |