- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $99.18 / $99.18 / $166.95
| Facility | 26 | $99.18 | $99.18 | $166.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.69 / $163.72 / $280.31
| Professional | | $139.69 | $163.72 | $280.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.48 / $297.97 / $297.97
| Professional | | $120.48 | $297.97 | $297.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.00 / $208.00 / $208.00
| Professional | | $208.00 | $208.00 | $208.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.02 / $208.25 / $266.61
| Professional | | $139.02 | $208.25 | $266.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $116.60
| Professional | | $32.34 | $32.34 | $116.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.58 / $172.15 / $249.00
| Professional | | $137.58 | $172.15 | $249.00 |