- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.00 / $61.91 / $135.94
| Facility | 26 | $56.00 | $61.91 | $135.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.13 / $331.86 / $664.73
| Professional | | $296.13 | $331.86 | $664.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.01 / $61.91 / $135.94
| Professional | 26 | $56.01 | $61.91 | $135.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.00 / $521.00 / $521.00
| Professional | | $521.00 | $521.00 | $521.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.69 / $473.51 / $793.18
| Professional | | $329.69 | $473.51 | $793.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.17 / $109.56 / $154.05
| Professional | 26 | $66.17 | $109.56 | $154.05 |
- 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
- $275.39 / $371.04 / $668.50
| Professional | | $275.39 | $371.04 | $668.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.86 / $66.56 / $154.68
| Professional | 26 | $54.86 | $66.56 | $154.68 |