- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.82 / $34.82 / $168.80
| Facility | 26 | $34.82 | $34.82 | $168.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.73 / $288.44 / $379.74
| Professional | | $220.73 | $288.44 | $379.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.94 / $375.61 / $628.22
| Professional | | $233.94 | $375.61 | $628.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.00 / $387.00 / $387.00
| Professional | | $387.00 | $387.00 | $387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.20 / $314.37 / $471.47
| Professional | | $267.20 | $314.37 | $471.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.40 / $361.35 / $639.96
| Professional | | $247.40 | $361.35 | $639.96 |