- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $88.59 / $184.51 / $184.51
| Facility | 26 | $88.59 | $184.51 | $184.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.63 / $132.82 / $186.00
| Professional | | $111.63 | $132.82 | $186.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.30 / $177.73 / $286.43
| Professional | | $121.30 | $177.73 | $286.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.71 / $211.25 / $418.58
| Professional | | $121.71 | $211.25 | $418.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.87 / $218.45 / $428.59
| Professional | | $136.87 | $218.45 | $428.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.29 / $201.95 / $482.54
| Professional | | $136.29 | $201.95 | $482.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.79 / $129.69 / $198.93
| Professional | | $93.79 | $129.69 | $198.93 |