- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $126.00 / $199.03 / $374.22
| Facility | 26 | $126.00 | $199.03 | $374.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $438.27 / $936.68
| Professional | | $400.00 | $438.27 | $936.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.39 / $428.99 / $904.00
| Professional | | $413.39 | $428.99 | $904.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $159.58 / $159.58 / $159.58
| Facility | 26 | $159.58 | $159.58 | $159.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.34 / $758.41 / $1,353.07
| Professional | | $380.34 | $758.41 | $1,353.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.00 / $658.08 / $1,653.06
| Professional | | $497.00 | $658.08 | $1,653.06 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $126.00 / $206.83 / $403.20
| Facility | 26 | $126.00 | $206.83 | $403.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.00 / $487.49 / $1,362.00
| Professional | | $425.00 | $487.49 | $1,362.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.44 / $760.12 / $1,080.09
| Professional | | $236.44 | $760.12 | $1,080.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $159.58 / $159.58 / $159.58
| Facility | 26 | $159.58 | $159.58 | $159.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.11 / $694.49 / $1,321.49
| Professional | | $396.11 | $694.49 | $1,321.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $136.97 / $136.97 / $141.84
| Facility | 26 | $136.97 | $136.97 | $141.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.54 / $424.97 / $784.01
| Professional | | $418.54 | $424.97 | $784.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.32 / $624.46 / $1,019.00
| Professional | | $432.32 | $624.46 | $1,019.00 |