- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.54 / $22.37 / $122.57
| Facility | 26 | $18.54 | $22.37 | $122.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.78 / $180.99 / $188.01
| Professional | | $178.78 | $180.99 | $188.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.65 / $291.30 / $297.49
| Professional | | $216.65 | $291.30 | $297.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.15 / $168.84 / $212.02
| Professional | | $123.15 | $168.84 | $212.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.63 / $297.00 / $297.00
| Facility | 26 | $52.63 | $297.00 | $297.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.01 / $210.85 / $9,009.00
| Professional | | $149.01 | $210.85 | $9,009.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.01 / $193.75 / $281.88
| Professional | | $149.01 | $193.75 | $281.88 |