- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.87 / $64.87 / $64.87
| Facility | 26 | $64.87 | $64.87 | $64.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.11 / $201.43 / $255.19
| Professional | | $169.11 | $201.43 | $255.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.37 / $201.87 / $238.21
| Professional | | $147.37 | $201.87 | $238.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.46 / $213.66 / $742.47
| Professional | | $136.46 | $213.66 | $742.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.63 / $182.62 / $268.04
| Professional | | $131.63 | $182.62 | $268.04 |