- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.38 / $51.38 / $115.13
| Facility | 26 | $51.38 | $51.38 | $115.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.99 / $137.43 / $214.90
| Professional | | $114.99 | $137.43 | $214.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.69 / $322.95 / $337.86
| Professional | | $261.69 | $322.95 | $337.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $78.58 / $78.58 / $78.58
| Facility | 26 | $78.58 | $78.58 | $78.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.22 / $208.04 / $344.01
| Professional | | $118.22 | $208.04 | $344.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.28 / $257.74 / $1,209.00
| Professional | | $139.28 | $257.74 | $1,209.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.28 / $235.12 / $317.49
| Professional | | $139.28 | $235.12 | $317.49 |