- 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
- $345.08 / $475.00 / $1,057.60
| Professional | | $345.08 | $475.00 | $1,057.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.93 / $821.23 / $2,652.77
| Professional | | $335.93 | $821.23 | $2,652.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $200.95 / $234.83 / $312.10
| Facility | 26 | $200.95 | $234.83 | $312.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.61 / $1,199.40 / $1,362.95
| Professional | | $481.61 | $1,199.40 | $1,362.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $720.40 / $720.40 / $720.40
| Facility | 26 | $720.40 | $720.40 | $720.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.12 / $1,050.47 / $3,350.26
| Professional | | $488.12 | $1,050.47 | $3,350.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.83 / $230.51 / $615.87
| Professional | | $80.83 | $230.51 | $615.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.95 / $976.72 / $1,459.46
| Professional | | $651.95 | $976.72 | $1,459.46 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $183.20 / $720.40 / $720.40
| Facility | 26 | $183.20 | $720.40 | $720.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.17 / $1,882.75 / $3,350.26
| Professional | | $505.17 | $1,882.75 | $3,350.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,012.27 / $2,137.25 / $2,607.51
| Professional | | $2,012.27 | $2,137.25 | $2,607.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.86 / $957.38 / $1,837.64
| Professional | | $451.86 | $957.38 | $1,837.64 |