- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.08 / $59.48 / $59.48
| Facility | 26 | $54.08 | $59.48 | $59.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.47 / $319.74 / $352.73
| Professional | | $286.47 | $319.74 | $352.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.21 / $510.55 / $630.74
| Professional | | $120.21 | $510.55 | $630.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.43 / $63.43 / $63.43
| Facility | 26 | $63.43 | $63.43 | $63.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.11 / $386.11 / $1,482.73
| Professional | | $248.11 | $386.11 | $1,482.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.03 / $289.38 / $546.66
| Professional | | $204.03 | $289.38 | $546.66 |