- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.63 / $53.63 / $73.50
| Facility | 26 | $53.63 | $53.63 | $73.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.10 / $110.43 / $275.00
| Professional | | $105.10 | $110.43 | $275.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.69 / $136.47 / $208.99
| Professional | | $124.69 | $136.47 | $208.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.02 / $71.54 / $138.61
| Professional | | $53.02 | $71.54 | $138.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.06 / $63.06 / $63.06
| Facility | 26 | $63.06 | $63.06 | $63.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.49 / $195.86 / $324.47
| Professional | | $102.49 | $195.86 | $324.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $138.85 / $209.16
| Professional | | $106.33 | $138.85 | $209.16 |