- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.14 / $197.79 / $394.35
| Facility | 26 | $51.14 | $197.79 | $394.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.70 / $430.29 / $430.29
| Professional | | $392.70 | $430.29 | $430.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.77 / $384.77 / $1,142.56
| Professional | | $384.77 | $384.77 | $1,142.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.98 / $452.12 / $2,155.51
| Professional | | $295.98 | $452.12 | $2,155.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.23 / $1,057.36 / $1,057.36
| Professional | | $484.23 | $1,057.36 | $1,057.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.88 / $126.66 / $126.66
| Professional | 26 | $57.88 | $126.66 | $126.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.25 / $687.70 / $1,499.09
| Professional | | $264.25 | $687.70 | $1,499.09 |