- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $166.95 / $240.75 / $311.18
| Facility | 26 | $166.95 | $240.75 | $311.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.84 / $600.00 / $1,421.00
| Professional | | $362.84 | $600.00 | $1,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.85 / $542.44 / $633.17
| Professional | | $236.85 | $542.44 | $633.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.91 / $379.33 / $703.51
| Professional | | $280.91 | $379.33 | $703.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.63 / $309.18 / $439.63
| Professional | | $242.63 | $309.18 | $439.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.47 / $448.24 / $1,030.81
| Professional | | $242.47 | $448.24 | $1,030.81 |