- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $536.41 / $536.41 / $536.41
| Facility | 26 | $536.41 | $536.41 | $536.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.50 / $161.32 / $877.45
| Professional | | $133.50 | $161.32 | $877.45 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $164.90 / $164.90 / $183.22
| Facility | 26 | $164.90 | $164.90 | $183.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.22 / $236.73 / $343.91
| Professional | | $201.22 | $236.73 | $343.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.98 / $286.61 / $405.21
| Professional | | $169.98 | $286.61 | $405.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.74 / $237.19 / $366.61
| Professional | | $147.74 | $237.19 | $366.61 |