- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.66 / $84.12 / $84.12
| Facility | 26 | $71.66 | $84.12 | $84.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.11 / $331.86 / $343.24
| Professional | | $288.11 | $331.86 | $343.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.35 / $59.90 / $62.82
| Professional | 26 | $55.35 | $59.90 | $62.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.69 / $334.76 / $450.43
| Professional | | $212.69 | $334.76 | $450.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.92 / $69.78 / $81.84
| Professional | 26 | $42.92 | $69.78 | $81.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.82 / $328.22 / $835.22
| Professional | | $214.82 | $328.22 | $835.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.81 / $79.68 / $152.19
| Professional | 26 | $59.81 | $79.68 | $152.19 |