- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $194.18 / $227.17 / $243.86
| Facility | 26 | $194.18 | $227.17 | $243.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.39 / $801.17 / $1,111.50
| Professional | | $447.39 | $801.17 | $1,111.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.66 / $683.81 / $759.79
| Professional | | $516.66 | $683.81 | $759.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.98 / $736.77 / $1,264.58
| Professional | | $428.98 | $736.77 | $1,264.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.83 / $754.05 / $1,075.84
| Professional | | $464.83 | $754.05 | $1,075.84 |