- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.73 / $74.73 / $74.73
| Facility | 26 | $74.73 | $74.73 | $74.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.14 / $276.83 / $276.83
| Professional | | $190.14 | $276.83 | $276.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.30 / $214.71 / $236.18
| Professional | | $150.30 | $214.71 | $236.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.14 / $339.01 / $1,226.65
| Professional | | $225.14 | $339.01 | $1,226.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.54 / $233.50 / $388.22
| Professional | | $169.54 | $233.50 | $388.22 |