- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.23 / $30.24 / $165.92
| Facility | 26 | $30.23 | $30.24 | $165.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.58 / $276.32 / $336.85
| Professional | | $208.58 | $276.32 | $336.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.41 / $383.18 / $651.29
| Professional | | $218.41 | $383.18 | $651.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.84 / $377.84 / $377.84
| Professional | | $377.84 | $377.84 | $377.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.13 / $306.04 / $442.60
| Professional | | $260.13 | $306.04 | $442.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.70 / $366.98 / $622.82
| Professional | | $263.70 | $366.98 | $622.82 |