- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.18 / $35.10 / $77.08
| Facility | 26 | $32.18 | $35.10 | $77.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.37 / $238.09 / $522.83
| Professional | | $149.37 | $238.09 | $522.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.19 / $35.10 / $77.08
| Professional | 26 | $32.19 | $35.10 | $77.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.00 / $415.00 / $415.00
| Professional | | $415.00 | $415.00 | $415.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.44 / $294.52 / $636.38
| Professional | | $218.44 | $294.52 | $636.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.83 / $63.94 / $87.84
| Professional | 26 | $37.83 | $63.94 | $87.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.73 / $275.44 / $403.63
| Professional | | $121.73 | $275.44 | $403.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.88 / $37.86 / $90.26
| Professional | 26 | $31.88 | $37.86 | $90.26 |