- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.65 / $60.93 / $100.25
| Facility | 26 | $38.65 | $60.93 | $100.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.31 / $212.52 / $668.89
| Professional | | $186.31 | $212.52 | $668.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.19 / $262.41 / $411.65
| Professional | | $213.19 | $262.41 | $411.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.53 / $309.64 / $479.02
| Professional | | $154.53 | $309.64 | $479.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $104.72 / $201.06 / $201.06
| Facility | 26 | $104.72 | $201.06 | $201.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.43 / $292.83 / $1,573.00
| Professional | | $207.43 | $292.83 | $1,573.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.03 / $292.83 / $478.61
| Professional | | $213.03 | $292.83 | $478.61 |