- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.34 / $78.13 / $134.74
| Facility | 26 | $70.34 | $78.13 | $134.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.34 / $198.69 / $364.84
| Professional | | $153.34 | $198.69 | $364.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.66 / $457.66 / $457.66
| Professional | | $457.66 | $457.66 | $457.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.80 / $479.06 / $662.30
| Professional | | $331.80 | $479.06 | $662.30 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.44 / $135.44 / $264.93
| Facility | 26 | $135.44 | $135.44 | $264.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.86 / $439.18 / $1,733.66
| Professional | | $317.86 | $439.18 | $1,733.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.86 / $428.03 / $733.50
| Professional | | $317.86 | $428.03 | $733.50 |