- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $572.82 / $572.82 / $572.82
| Facility | 26 | $572.82 | $572.82 | $572.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.66 / $191.95 / $1,115.73
| Professional | | $140.66 | $191.95 | $1,115.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.53 / $91.04 / $331.96
| Professional | 26 | $72.53 | $91.04 | $331.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.60 / $221.88 / $370.46
| Professional | | $188.60 | $221.88 | $370.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.55 / $110.79 / $180.61
| Professional | 26 | $77.55 | $110.79 | $180.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.64 / $261.42 / $361.30
| Professional | | $177.64 | $261.42 | $361.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $86.66 / $134.25 / $191.66
| Professional | 26 | $86.66 | $134.25 | $191.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.81 / $226.77 / $351.66
| Professional | | $180.81 | $226.77 | $351.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.21 / $116.06 / $174.34
| Professional | 26 | $82.21 | $116.06 | $174.34 |