- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.47 / $31.77 / $52.27
| Facility | 26 | $25.47 | $31.77 | $52.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.85 / $217.92 / $263.25
| Professional | | $214.85 | $217.92 | $263.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.43 / $285.43 / $285.43
| Professional | | $285.43 | $285.43 | $285.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.43 / $243.52 / $449.17
| Professional | | $155.43 | $243.52 | $449.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.63 / $52.63 / $52.63
| Facility | 26 | $52.63 | $52.63 | $52.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.63 / $220.03 / $9,009.00
| Professional | | $142.63 | $220.03 | $9,009.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.81 / $220.03 / $412.50
| Professional | | $150.81 | $220.03 | $412.50 |