- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.91 / $310.44 / $523.26
| Facility | 26 | $57.91 | $310.44 | $523.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.60 / $193.60 / $1,338.04
| Professional | | $193.60 | $193.60 | $1,338.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.91 / $57.91 / $359.20
| Professional | 26 | $57.91 | $57.91 | $359.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.67 / $376.95 / $400.75
| Professional | | $352.67 | $376.95 | $400.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.13 / $113.44 / $119.87
| Professional | 26 | $106.13 | $113.44 | $119.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $334.74 / $334.74 / $334.74
| Facility | 26 | $334.74 | $334.74 | $334.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.24 / $450.23 / $684.95
| Professional | | $301.24 | $450.23 | $684.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.06 / $132.26 / $170.65
| Professional | 26 | $76.06 | $132.26 | $170.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $565.04 / $565.04 / $565.04
| Facility | 26 | $565.04 | $565.04 | $565.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.12 / $468.44 / $2,293.84
| Professional | | $280.12 | $468.44 | $2,293.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.09 / $122.77 / $523.40
| Professional | 26 | $73.09 | $122.77 | $523.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $194.33 / $199.99 / $334.74
| Facility | 26 | $194.33 | $199.99 | $334.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.94 / $549.47 / $705.00
| Professional | | $381.94 | $549.47 | $705.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.51 / $186.39 / $330.69
| Professional | | $60.51 | $186.39 | $330.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.12 / $433.17 / $618.82
| Professional | | $280.12 | $433.17 | $618.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.09 / $120.61 / $150.36
| Professional | 26 | $73.09 | $120.61 | $150.36 |