- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.17 / $32.17 / $37.13
| Facility | 26 | $32.17 | $32.17 | $37.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.92 / $101.92 / $126.01
| Professional | | $101.92 | $101.92 | $126.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.63 / $23.63 / $32.18
| Professional | 26 | $23.63 | $23.63 | $32.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.27 / $72.84 / $259.88
| Professional | | $53.27 | $72.84 | $259.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.05 / $23.47 / $103.86
| Professional | 26 | $18.05 | $23.47 | $103.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.67 / $112.31 / $314.42
| Professional | | $70.67 | $112.31 | $314.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.64 / $26.75 / $89.87
| Professional | 26 | $22.64 | $26.75 | $89.87 |