- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Facility | 26 | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $100.00 / $245.47
| Professional | | $67.61 | $100.00 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.98 / $64.57 / $208.93
| Professional | 26 | $48.98 | $64.57 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $134.90 / $194.98
| Professional | | $95.50 | $134.90 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $95.50 / $138.04
| Professional | 26 | $67.61 | $95.50 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $213.80 / $331.13
| Professional | | $123.03 | $213.80 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $134.90 / $194.98
| Professional | 26 | $85.11 | $134.90 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $177.83 / $288.40
| Professional | | $107.15 | $177.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $125.89 / $213.80
| Professional | 26 | $77.62 | $125.89 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $141.25 / $275.42
| Professional | | $112.20 | $141.25 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $87.10 / $169.82
| Professional | 26 | $70.79 | $87.10 | $169.82 |