- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.74 / $31.74 / $31.74
| Facility | 26 | $31.74 | $31.74 | $31.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.22 / $166.25 / $175.30
| Professional | | $101.22 | $166.25 | $175.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.03 / $128.81 / $152.00
| Professional | | $94.03 | $128.81 | $152.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.30 / $20.30 / $20.47
| Facility | 26 | $20.30 | $20.30 | $20.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.00 / $91.38 / $202.30
| Professional | | $59.00 | $91.38 | $202.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.08 / $119.27 / $166.98
| Professional | | $66.08 | $119.27 | $166.98 |