- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.84 / $16.48 / $31.99
| Facility | 26 | $15.84 | $16.48 | $31.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.34 / $58.71 / $107.74
| Professional | | $45.34 | $58.71 | $107.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.73 / $72.73 / $72.73
| Professional | | $72.73 | $72.73 | $72.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.69 / $70.72 / $110.23
| Professional | | $48.69 | $70.72 | $110.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.53 / $33.53 / $100.00
| Facility | 26 | $33.53 | $33.53 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.01 / $71.04 / $500.00
| Professional | | $55.01 | $71.04 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.41 / $66.45 / $96.41
| Professional | | $53.41 | $66.45 | $96.41 |