- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $33.11 / $45.71
| Facility | 26 | $33.11 | $33.11 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $229.09 / $467.74
| Professional | | $151.36 | $229.09 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $269.15 / $1,230.27
| Professional | | $194.98 | $269.15 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $67.61 / $107.15
| Facility | 26 | $57.54 | $67.61 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $707.95 / $933.25
| Professional | | $346.74 | $707.95 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $512.86 / $616.60
| Professional | | $416.87 | $512.86 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $309.03 / $1,174.90
| Professional | | $177.83 | $309.03 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $446.68
| Professional | | $32.36 | $50.12 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $537.03 / $776.25
| Professional | | $173.78 | $537.03 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $295.12 / $295.12
| Facility | 26 | $100.00 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,047.13 / $8,912.51
| Professional | | $316.23 | $1,047.13 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,000.00 / $1,698.24
| Professional | | $426.58 | $1,000.00 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $275.42 / $794.33
| Professional | | $177.83 | $275.42 | $794.33 |