- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.44 / $178.10 / $178.10
| Facility | 26 | $85.44 | $178.10 | $178.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.76 / $197.13 / $467.40
| Professional | | $159.76 | $197.13 | $467.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.03 / $367.37 / $515.08
| Professional | | $163.03 | $367.37 | $515.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.58 / $592.42 / $1,045.46
| Professional | | $364.58 | $592.42 | $1,045.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.67 / $611.04 / $1,144.07
| Professional | | $370.67 | $611.04 | $1,144.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.85 / $529.03 / $1,227.80
| Professional | | $353.85 | $529.03 | $1,227.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.27 / $149.90 / $190.78
| Professional | | $136.27 | $149.90 | $190.78 |