- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.78 / $21.70 / $47.66
| Facility | 26 | $19.78 | $21.70 | $47.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.85 / $255.17 / $350.65
| Professional | | $156.85 | $255.17 | $350.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.00 / $271.00 / $271.00
| Professional | | $271.00 | $271.00 | $271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.11 / $253.44 / $418.54
| Professional | | $177.11 | $253.44 | $418.54 |
- 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
- $142.82 / $201.74 / $357.79
| Professional | | $142.82 | $201.74 | $357.79 |