- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.43 / $79.31 / $133.50
| Facility | 26 | $71.43 | $79.31 | $133.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.56 / $176.51 / $283.70
| Professional | | $158.56 | $176.51 | $283.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.51 / $72.19 / $133.50
| Professional | 26 | $64.51 | $72.19 | $133.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.00 / $226.00 / $226.00
| Professional | | $226.00 | $226.00 | $226.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.11 / $203.09 / $275.60
| Professional | | $149.11 | $203.09 | $275.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.89 / $95.04 / $130.00
| Professional | 26 | $67.89 | $95.04 | $130.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $55.96
| Professional | | $32.34 | $32.34 | $55.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.85 / $174.08 / $265.20
| Professional | | $134.85 | $174.08 | $265.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.05 / $77.00 / $123.84
| Professional | 26 | $61.05 | $77.00 | $123.84 |