- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.94 / $86.09 / $193.15
| Facility | 26 | $37.94 | $86.09 | $193.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.47 / $99.34 / $354.25
| Professional | | $86.47 | $99.34 | $354.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.52 / $161.06 / $345.08
| Professional | | $100.52 | $161.06 | $345.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $49.75 / $49.75 / $49.75
| Facility | 26 | $49.75 | $49.75 | $49.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.90 / $214.01 / $405.29
| Professional | | $101.90 | $214.01 | $405.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.50 / $215.46 / $611.62
| Professional | | $118.50 | $215.46 | $611.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.09 / $73.48 / $158.63
| Professional | 26 | $46.09 | $73.48 | $158.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.38 / $99.18 / $192.57
| Professional | | $54.38 | $99.18 | $192.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.32 / $175.52 / $327.64
| Professional | | $104.32 | $175.52 | $327.64 |