- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $229.09 / $295.12 / $295.12
| Facility | 26 | $229.09 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $426.58 / $724.44
| Professional | | $288.40 | $426.58 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $1,659.59
| Professional | | $281.84 | $446.68 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $288.40 / $338.84 / $537.03
| Facility | 26 | $288.40 | $338.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $676.08 / $1,174.90
| Professional | | $295.12 | $676.08 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $616.60 / $851.14
| Professional | | $512.86 | $616.60 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | 26 | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $707.95 / $3,162.28
| Professional | | $371.54 | $707.95 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $398.11
| Professional | | $32.36 | $33.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $707.95 / $1,258.93
| Professional | | $363.08 | $707.95 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $257.04 / $1,000.00 / $1,000.00
| Facility | 26 | $257.04 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,548.82 / $3,162.28
| Professional | | $407.38 | $1,548.82 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,778.28 / $2,398.83
| Professional | | $1,621.81 | $1,778.28 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $562.34 / $1,202.26
| Professional | | $323.59 | $562.34 | $1,202.26 |