- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.43 / $197.14 / $256.36
| Facility | 26 | $66.43 | $197.14 | $256.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.36 / $187.28 / $730.00
| Professional | | $109.36 | $187.28 | $730.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.45 / $181.72 / $233.19
| Professional | | $116.45 | $181.72 | $233.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.82 / $184.55 / $286.45
| Professional | | $138.82 | $184.55 | $286.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.03 / $145.32 / $188.42
| Professional | | $127.03 | $145.32 | $188.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.19 / $171.00 / $253.03
| Professional | | $89.19 | $171.00 | $253.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.01 / $175.06 / $345.26
| Professional | | $107.01 | $175.06 | $345.26 |