- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.57 / $36.57 / $36.57
| Facility | 26 | $36.57 | $36.57 | $36.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.51 / $184.63 / $215.86
| Professional | | $156.51 | $184.63 | $215.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.61 / $401.81 / $502.27
| Professional | | $328.61 | $401.81 | $502.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.21 / $245.54 / $416.37
| Professional | | $164.21 | $245.54 | $416.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.00 / $366.60 / $499.06
| Professional | | $233.00 | $366.60 | $499.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.34 / $290.51 / $333.43
| Professional | | $199.34 | $290.51 | $333.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.91 / $60.71 / $69.22
| Professional | 26 | $45.91 | $60.71 | $69.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.41 / $227.89 / $377.10
| Professional | | $207.41 | $227.89 | $377.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.30 / $343.90 / $343.90
| Professional | | $292.30 | $343.90 | $343.90 |