- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $97.01 / $106.71 / $106.71
| Facility | 26 | $97.01 | $106.71 | $106.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.44 / $229.49 / $244.82
| Professional | | $165.44 | $229.49 | $244.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.95 / $113.03 / $258.85
| Professional | | $57.95 | $113.03 | $258.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $113.41 / $113.41 / $113.41
| Facility | 26 | $113.41 | $113.41 | $113.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.71 / $306.54 / $556.52
| Professional | | $193.71 | $306.54 | $556.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.26 / $205.50 / $364.64
| Professional | | $155.26 | $205.50 | $364.64 |