- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.06 / $68.20 / $153.06
| Facility | 26 | $30.06 | $68.20 | $153.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.32 / $214.28 / $600.00
| Professional | | $175.32 | $214.28 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.51 / $260.16 / $506.02
| Professional | | $181.51 | $260.16 | $506.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.61 / $342.37 / $583.58
| Professional | | $206.61 | $342.37 | $583.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.13 / $362.08 / $540.27
| Professional | | $227.13 | $362.08 | $540.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.81 / $58.68 / $106.05
| Professional | 26 | $36.81 | $58.68 | $106.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.64 / $261.27 / $313.75
| Professional | | $49.64 | $261.27 | $313.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.47 / $271.97 / $509.70
| Professional | | $194.47 | $271.97 | $509.70 |