- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.88 / $116.42 / $191.56
| Facility | 26 | $96.88 | $116.42 | $191.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.11 / $128.60 / $157.41
| Professional | | $88.11 | $128.60 | $157.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.00 / $245.00 / $245.00
| Professional | | $245.00 | $245.00 | $245.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.72 / $189.59 / $300.00
| Professional | | $117.72 | $189.59 | $300.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $198.65 / $198.65 / $198.65
| Facility | 26 | $198.65 | $198.65 | $198.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.47 / $194.07 / $1,114.00
| Professional | | $141.47 | $194.07 | $1,114.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.41 / $166.10 / $267.83
| Professional | | $138.41 | $166.10 | $267.83 |