- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.85 / $41.12 / $79.18
| Facility | 26 | $33.85 | $41.12 | $79.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.63 / $217.43 / $388.53
| Professional | | $192.63 | $217.43 | $388.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.39 / $253.33 / $399.03
| Professional | | $198.39 | $253.33 | $399.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.42 / $39.42 / $39.42
| Facility | 26 | $39.42 | $39.42 | $39.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.88 / $296.79 / $519.00
| Professional | | $189.88 | $296.79 | $519.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.72 / $256.50 / $476.44
| Professional | | $180.72 | $256.50 | $476.44 |