- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $92.01 / $92.01 / $92.01
| Facility | 26 | $92.01 | $92.01 | $92.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.62 / $433.90 / $613.51
| Professional | | $268.62 | $433.90 | $613.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.02 / $579.42 / $869.15
| Professional | | $291.02 | $579.42 | $869.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.93 / $530.16 / $768.23
| Professional | | $274.93 | $530.16 | $768.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.33 / $594.75 / $892.13
| Professional | | $416.33 | $594.75 | $892.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $92.89 / $129.16 / $199.06
| Professional | 26 | $92.89 | $129.16 | $199.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.27 / $468.47 / $885.62
| Professional | | $284.27 | $468.47 | $885.62 |