- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $251.19 / $302.00 / $407.38
| Facility | 26 | $251.19 | $302.00 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $457.09 / $1,071.52
| Professional | | $281.84 | $457.09 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $141.25 / $323.59
| Professional | 26 | $83.18 | $141.25 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $125.89
| Professional | 26 | $100.00 | $100.00 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $354.81 / $630.96
| Professional | | $275.42 | $354.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $93.33 / $165.96
| Professional | 26 | $74.13 | $93.33 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.42 / $95.50 / $138.04
| Facility | 26 | $20.42 | $95.50 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $446.68 / $851.14
| Professional | | $229.09 | $446.68 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $104.71 / $186.21
| Professional | 26 | $64.57 | $104.71 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $616.60 / $794.33 / $794.33
| Facility | 26 | $616.60 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $501.19 / $3,467.37
| Professional | | $269.15 | $501.19 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $91.20 / $707.95
| Professional | 26 | $77.62 | $91.20 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $660.69
| Professional | | $269.15 | $416.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $81.28 / $147.91
| Professional | 26 | $77.62 | $81.28 | $147.91 |