- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $100.00 / $154.88
| Facility | 26 | $70.79 | $100.00 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $234.42 / $416.87
| Professional | | $151.36 | $234.42 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $1,148.15
| Professional | | $107.15 | $107.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $162.18 / $186.21 / $302.00
| Facility | 26 | $162.18 | $186.21 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $380.19 / $891.25
| Professional | | $125.89 | $380.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $812.83
| Professional | | $724.44 | $724.44 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Facility | 26 | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $269.15 / $1,819.70
| Professional | | $138.04 | $269.15 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $54.95 / $251.19
| Professional | | $32.36 | $54.95 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $630.96 / $870.96
| Professional | | $288.40 | $630.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $112.20 / $380.19 / $380.19
| Facility | 26 | $112.20 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $831.76 / $1,819.70
| Professional | | $114.82 | $831.76 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $1,412.54
| Professional | | $186.21 | $186.21 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $257.04 / $478.63
| Professional | | $138.04 | $257.04 | $478.63 |