- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $76.26 / $76.26 / $76.26
| Facility | 26 | $76.26 | $76.26 | $76.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.19 / $236.09 / $719.10
| Professional | | $215.19 | $236.09 | $719.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.32 / $480.38 / $566.16
| Professional | | $408.32 | $480.38 | $566.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.22 / $505.65 / $652.97
| Professional | | $312.22 | $505.65 | $652.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.98 / $377.30 / $564.09
| Professional | | $217.98 | $377.30 | $564.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.38 / $394.77 / $564.09
| Professional | | $226.38 | $394.77 | $564.09 |