- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $119.08 / $119.08 / $119.08
| Facility | 26 | $119.08 | $119.08 | $119.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.34 / $405.82 / $519.46
| Professional | | $359.34 | $405.82 | $519.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.24 / $540.54 / $801.26
| Professional | | $320.24 | $540.54 | $801.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.38 / $568.86 / $774.61
| Professional | | $323.38 | $568.86 | $774.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.44 / $580.64 / $823.00
| Professional | | $406.44 | $580.64 | $823.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.64 / $156.63 / $241.38
| Professional | 26 | $112.64 | $156.63 | $241.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.80 / $540.47 / $1,348.43
| Professional | | $345.80 | $540.47 | $1,348.43 |