- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $105.59 / $105.59 / $107.57
| Facility | 26 | $105.59 | $105.59 | $107.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.72 / $465.17 / $475.00
| Professional | | $291.72 | $465.17 | $475.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.00 / $1,219.00 / $2,252.00
| Professional | | $742.00 | $1,219.00 | $2,252.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.10 / $596.96 / $1,000.00
| Professional | | $414.10 | $596.96 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.79 / $627.57 / $1,353.01
| Professional | | $381.79 | $627.57 | $1,353.01 |