- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $53.70 / $64.57
| Facility | 26 | $53.70 | $53.70 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $199.53 / $302.00
| Professional | | $173.78 | $199.53 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $199.53 / $309.03
| Professional | | $131.83 | $199.53 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $234.42 / $316.23
| Professional | | $194.98 | $234.42 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $245.47 / $436.52
| Professional | | $165.96 | $245.47 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $120.23 / $234.42 / $234.42
| Facility | 26 | $120.23 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $251.19 / $1,318.26
| Professional | | $165.96 | $251.19 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $223.87 / $380.19
| Professional | | $158.49 | $223.87 | $380.19 |