- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.72 / $50.72 / $112.21
| Facility | 26 | $50.72 | $50.72 | $112.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.25 / $413.20 / $1,004.81
| Professional | | $369.25 | $413.20 | $1,004.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.37 / $188.45 / $809.22
| Professional | | $66.37 | $188.45 | $809.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.30 / $603.38 / $852.38
| Professional | | $263.30 | $603.38 | $852.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $109.50 / $679.69
| Professional | | $32.34 | $109.50 | $679.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.55 / $603.38 / $852.38
| Professional | | $285.55 | $603.38 | $852.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.12 / $594.13 / $1,001.72
| Professional | | $403.12 | $594.13 | $1,001.72 |