- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.07 / $47.07 / $75.15
| Facility | 26 | $47.07 | $47.07 | $75.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.12 / $230.04 / $360.00
| Professional | | $215.12 | $230.04 | $360.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.83 / $492.76 / $542.05
| Professional | | $409.83 | $492.76 | $542.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.62 / $403.36 / $526.17
| Professional | | $292.62 | $403.36 | $526.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.08 / $461.21 / $1,573.00
| Professional | | $249.08 | $461.21 | $1,573.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.08 / $440.45 / $599.72
| Professional | | $249.08 | $440.45 | $599.72 |