- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.42 / $104.42 / $176.00
| Facility | 26 | $19.42 | $104.42 | $176.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.82 / $165.82 / $1,130.11
| Professional | | $165.82 | $165.82 | $1,130.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.69 / $323.54 / $331.63
| Professional | | $302.69 | $323.54 | $331.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $111.06 / $111.06 / $111.06
| Facility | 26 | $111.06 | $111.06 | $111.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.81 / $413.45 / $516.80
| Professional | | $327.81 | $413.45 | $516.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.50 / $348.22 / $500.12
| Professional | | $181.50 | $348.22 | $500.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $65.81 / $67.73 / $111.06
| Facility | 26 | $65.81 | $67.73 | $111.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.43 / $373.60 / $510.91
| Professional | | $228.43 | $373.60 | $510.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.76 / $348.22 / $447.43
| Professional | | $214.76 | $348.22 | $447.43 |