- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.70 / $79.70 / $147.19
| Facility | 26 | $79.70 | $79.70 | $147.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.49 / $148.59 / $240.97
| Professional | | $134.49 | $148.59 | $240.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.84 / $272.77 / $272.77
| Professional | | $137.84 | $272.77 | $272.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.39 / $198.36 / $307.45
| Professional | | $111.39 | $198.36 | $307.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.32 / $206.86 / $365.37
| Professional | | $153.32 | $206.86 | $365.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.09 / $185.65 / $657.00
| Professional | | $157.09 | $185.65 | $657.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.31 / $106.73 / $387.63
| Professional | 26 | $90.31 | $106.73 | $387.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.98 / $125.78 / $252.29
| Professional | | $67.98 | $125.78 | $252.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.00 / $214.97 / $366.17
| Professional | | $144.00 | $214.97 | $366.17 |