- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $39.81 / $53.74
| Facility | 26 | $39.81 | $39.81 | $53.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.55 / $271.77 / $366.90
| Professional | | $159.55 | $271.77 | $366.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.76 / $39.81 / $53.74
| Professional | 26 | $26.76 | $39.81 | $53.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.30 / $249.00 / $273.89
| Professional | | $174.30 | $249.00 | $273.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.90 / $67.00 / $73.70
| Professional | 26 | $46.90 | $67.00 | $73.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.55 / $286.70 / $980.13
| Professional | | $180.55 | $286.70 | $980.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.89 / $44.89 / $176.10
| Professional | 26 | $31.89 | $44.89 | $176.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.01 / $196.46 / $267.52
| Professional | | $130.01 | $196.46 | $267.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.74 / $29.48 / $41.25
| Professional | 26 | $22.74 | $29.48 | $41.25 |