- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.86 / $136.78 / $136.78
| Facility | 26 | $51.86 | $136.78 | $136.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.63 / $198.04 / $622.24
| Professional | | $192.63 | $198.04 | $622.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.69 / $303.45 / $440.01
| Professional | | $206.69 | $303.45 | $440.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.32 / $496.90 / $700.78
| Professional | | $276.32 | $496.90 | $700.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.67 / $420.52 / $935.58
| Professional | | $240.67 | $420.52 | $935.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.58 / $304.01 / $1,668.07
| Professional | | $201.58 | $304.01 | $1,668.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.13 / $226.74 / $342.45
| Professional | | $194.13 | $226.74 | $342.45 |