- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $117.03 / $283.13 / $353.89
| Facility | 26 | $117.03 | $283.13 | $353.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.00 / $155.00 / $291.50
| Professional | 26 | $90.00 | $155.00 | $291.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.98 / $82.64 / $400.29
| Professional | 26 | $61.98 | $82.64 | $400.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.08 / $114.92 / $177.05
| Professional | 26 | $58.08 | $114.92 | $177.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $197.95 / $1,566.00 / $1,566.00
| Facility | 26 | $197.95 | $1,566.00 | $1,566.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.45 / $85.60 / $2,660.92
| Professional | 26 | $75.45 | $85.60 | $2,660.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.45 / $83.48 / $182.28
| Professional | 26 | $75.45 | $83.48 | $182.28 |