- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.20 / $141.49 / $403.20
| Facility | 26 | $107.20 | $141.49 | $403.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.17 / $420.00 / $516.00
| Professional | | $270.17 | $420.00 | $516.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.59 / $158.59 / $315.94
| Professional | | $158.59 | $158.59 | $315.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.00 / $267.74 / $712.99
| Professional | | $258.00 | $267.74 | $712.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.60 / $87.60 / $87.60
| Facility | 26 | $87.60 | $87.60 | $87.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.61 / $515.00 / $988.14
| Professional | | $255.61 | $515.00 | $988.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.55 / $413.46 / $1,466.01
| Professional | | $311.55 | $413.46 | $1,466.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.20 / $165.06 / $412.02
| Facility | 26 | $107.20 | $165.06 | $412.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.94 / $425.00 / $1,037.00
| Professional | | $272.94 | $425.00 | $1,037.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.69 / $273.95 / $700.00
| Professional | | $87.69 | $273.95 | $700.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.01 / $87.60 / $87.60
| Facility | 26 | $53.01 | $87.60 | $87.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.74 / $500.00 / $927.03
| Professional | | $267.74 | $500.00 | $927.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $76.01 / $76.01 / $89.00
| Facility | 26 | $76.01 | $76.01 | $89.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.38 / $263.48 / $589.00
| Professional | | $259.38 | $263.48 | $589.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.52 / $397.93 / $688.28
| Professional | | $264.52 | $397.93 | $688.28 |