- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $82.01 / $120.41 / $278.11
| Facility | 26 | $82.01 | $120.41 | $278.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.26 / $182.46 / $369.52
| Professional | | $90.26 | $182.46 | $369.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.60 / $288.50 / $464.27
| Professional | | $129.60 | $288.50 | $464.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.89 / $196.84 / $553.20
| Professional | | $85.89 | $196.84 | $553.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.84 / $404.97 / $595.89
| Professional | | $199.84 | $404.97 | $595.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.24 / $366.77 / $845.65
| Professional | | $170.24 | $366.77 | $845.65 |