- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $108.04 / $108.04 / $108.04
| Facility | 26 | $108.04 | $108.04 | $108.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.36 / $240.85 / $367.79
| Professional | | $186.36 | $240.85 | $367.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.19 / $513.64 / $575.28
| Professional | | $427.19 | $513.64 | $575.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.91 / $473.65 / $740.16
| Professional | | $193.91 | $473.65 | $740.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.15 / $464.66 / $1,539.23
| Professional | | $255.15 | $464.66 | $1,539.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.15 / $445.46 / $579.37
| Professional | | $255.15 | $445.46 | $579.37 |