- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $41.20 / $194.44 / $208.06
| Facility | 26 | $41.20 | $194.44 | $208.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.45 / $360.96 / $571.52
| Professional | | $317.45 | $360.96 | $571.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.48 / $550.41 / $986.65
| Professional | | $392.48 | $550.41 | $986.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.81 / $55.81 / $55.81
| Facility | 26 | $55.81 | $55.81 | $55.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.20 / $699.12 / $1,217.69
| Professional | | $402.20 | $699.12 | $1,217.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.73 / $673.91 / $3,670.84
| Professional | | $422.73 | $673.91 | $3,670.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.38 / $81.91 / $404.17
| Professional | 26 | $51.38 | $81.91 | $404.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.23 / $502.66 / $817.39
| Professional | | $69.23 | $502.66 | $817.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.11 / $592.54 / $1,064.49
| Professional | | $399.11 | $592.54 | $1,064.49 |