- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.02 / $32.02 / $61.91
| Facility | 26 | $32.02 | $32.02 | $61.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.78 / $157.71 / $341.50
| Professional | | $128.78 | $157.71 | $341.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.32 / $253.32 / $253.32
| Professional | | $253.32 | $253.32 | $253.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.90 / $215.91 / $489.27
| Professional | | $119.90 | $215.91 | $489.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $61.36 / $61.36 / $61.36
| Facility | 26 | $61.36 | $61.36 | $61.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.78 / $172.88 / $1,025.66
| Professional | | $101.78 | $172.88 | $1,025.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.78 / $163.71 / $311.91
| Professional | | $101.78 | $163.71 | $311.91 |