- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $165.35 / $449.76 / $449.76
| Facility | 26 | $165.35 | $449.76 | $449.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $445.14 / $1,320.50
| Professional | | $400.00 | $445.14 | $1,320.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.36 / $581.91 / $822.93
| Professional | | $272.36 | $581.91 | $822.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.22 / $652.29 / $1,106.98
| Professional | | $372.22 | $652.29 | $1,106.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.79 / $554.11 / $1,027.07
| Professional | | $311.79 | $554.11 | $1,027.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.06 / $487.76 / $879.18
| Professional | | $402.06 | $487.76 | $879.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.43 / $365.09 / $547.64
| Professional | | $296.43 | $365.09 | $547.64 |