- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $87.10 / $109.65
| Facility | 26 | $85.11 | $87.10 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $354.81
| Professional | | $147.91 | $234.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $371.54 / $398.11
| Professional | | $257.04 | $371.54 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $229.09 / $489.78
| Professional | | $169.82 | $229.09 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $134.90 / $158.49
| Facility | 26 | $57.54 | $134.90 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $229.09 / $380.19
| Professional | | $138.04 | $229.09 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $223.87 / $537.03
| Professional | | $165.96 | $223.87 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $223.87 / $302.00
| Professional | | $173.78 | $223.87 | $302.00 |