- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.94 / $131.49 / $228.64
| Facility | 26 | $125.94 | $131.49 | $228.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.58 / $830.24 / $1,650.75
| Professional | | $741.58 | $830.24 | $1,650.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,078.00 / $1,078.00
| Professional | | $1,078.00 | $1,078.00 | $1,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.37 / $1,145.57 / $1,306.77
| Professional | | $695.37 | $1,145.57 | $1,306.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.73 / $894.08 / $2,187.17
| Professional | | $746.73 | $894.08 | $2,187.17 |