- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $87.10 / $144.54
| Facility | 26 | $85.11 | $87.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $138.04 / $204.17
| Professional | | $104.71 | $138.04 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $288.40 / $346.74
| Professional | | $234.42 | $288.40 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $257.04 / $323.59
| Professional | | $177.83 | $257.04 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $257.04 / $1,122.02
| Professional | | $141.25 | $257.04 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $251.19 / $354.81
| Professional | | $134.90 | $251.19 | $354.81 |