- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Facility | 26 | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $524.81 / $1,000.00
| Professional | | $416.87 | $524.81 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $97.72 / $165.96
| Professional | 26 | $70.79 | $97.72 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $61.66 / $61.66
| Facility | 26 | $53.70 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $912.01 / $1,513.56
| Professional | | $676.08 | $912.01 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $114.82 / $151.36 / $251.19
| Professional | 26 | $114.82 | $151.36 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $114.82 / $251.19 / $616.60
| Facility | 26 | $114.82 | $251.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $812.83 / $1,348.96
| Professional | | $645.65 | $812.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $134.90 / $223.87
| Professional | 26 | $107.15 | $134.90 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $199.53 / $251.19 / $489.78
| Facility | 26 | $199.53 | $251.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $1,000.00
| Professional | | $645.65 | $645.65 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.71 / $104.71 / $165.96
| Professional | 26 | $104.71 | $104.71 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $812.83 / $2,754.23
| Professional | | $467.74 | $812.83 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $138.04 / $436.52
| Professional | 26 | $81.28 | $138.04 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $831.76 / $1,659.59
| Professional | | $512.86 | $831.76 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $138.04 / $263.03
| Professional | 26 | $83.18 | $138.04 | $263.03 |