- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $126.07 / $126.07 / $126.07
| Facility | 26 | $126.07 | $126.07 | $126.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.27 / $240.85 / $347.69
| Professional | | $212.27 | $240.85 | $347.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.45 / $221.70 / $333.16
| Professional | | $188.45 | $221.70 | $333.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.06 / $187.22 / $508.50
| Professional | | $81.06 | $187.22 | $508.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.75 / $305.50 / $425.04
| Professional | | $189.75 | $305.50 | $425.04 |