- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $160.66 / $160.66 / $179.38
| Facility | 26 | $160.66 | $160.66 | $179.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.33 / $475.00 / $856.29
| Professional | | $286.33 | $475.00 | $856.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.33 / $691.90 / $2,141.27
| Professional | | $271.33 | $691.90 | $2,141.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $200.05 / $233.77 / $310.70
| Facility | 26 | $200.05 | $233.77 | $310.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.44 / $970.83 / $1,103.21
| Professional | | $390.44 | $970.83 | $1,103.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $717.20 / $717.20 / $717.20
| Facility | 26 | $717.20 | $717.20 | $717.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.88 / $936.21 / $3,348.15
| Professional | | $388.88 | $936.21 | $3,348.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.47 / $190.52 / $494.25
| Professional | | $80.47 | $190.52 | $494.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.45 / $791.70 / $1,326.78
| Professional | | $528.45 | $791.70 | $1,326.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $182.43 / $717.20 / $717.20
| Facility | 26 | $182.43 | $717.20 | $717.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.25 / $1,834.75 / $3,348.15
| Professional | | $415.25 | $1,834.75 | $3,348.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,700.43 / $1,729.86 / $2,531.25
| Professional | | $1,700.43 | $1,729.86 | $2,531.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.02 / $807.68 / $1,513.10
| Professional | | $341.02 | $807.68 | $1,513.10 |