- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $108.84 / $108.84 / $117.55
| Facility | 26 | $108.84 | $108.84 | $117.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.41 / $232.71 / $343.56
| Professional | | $175.41 | $232.71 | $343.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.33 / $214.33 / $214.33
| Professional | | $214.33 | $214.33 | $214.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.38 / $229.58 / $356.07
| Professional | | $139.38 | $229.58 | $356.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.63 / $265.01 / $428.65
| Professional | | $156.63 | $265.01 | $428.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.24 / $254.12 / $445.41
| Professional | | $165.24 | $254.12 | $445.41 |