- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $76.59 / $104.25 / $125.58
| Facility | 26 | $76.59 | $104.25 | $125.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.26 / $437.55 / $590.15
| Professional | | $327.26 | $437.55 | $590.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.09 / $548.05 / $608.96
| Professional | | $414.09 | $548.05 | $608.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.41 / $568.16 / $849.66
| Professional | | $289.41 | $568.16 | $849.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.43 / $427.77 / $855.54
| Professional | | $240.43 | $427.77 | $855.54 |