- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $118.59 / $286.98 / $601.10
| Facility | 26 | $118.59 | $286.98 | $601.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $425.00
| Professional | | $400.00 | $400.00 | $425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.36 / $473.60 / $1,756.65
| Professional | | $462.36 | $473.60 | $1,756.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.23 / $692.02 / $1,252.82
| Professional | | $374.23 | $692.02 | $1,252.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.32 / $331.01 / $639.92
| Professional | | $276.32 | $331.01 | $639.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.73 / $88.86 / $168.17
| Professional | 26 | $76.73 | $88.86 | $168.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.20 / $452.67 / $985.82
| Professional | | $263.20 | $452.67 | $985.82 |