- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.43 / $440.14 / $741.89
| Facility | 26 | $81.43 | $440.14 | $741.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.58 / $252.89 / $1,518.64
| Professional | | $210.58 | $252.89 | $1,518.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.26 / $190.25 / $439.00
| Professional | 26 | $81.26 | $190.25 | $439.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.06 / $87.27 / $87.27
| Professional | 26 | $82.06 | $87.27 | $87.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.12 / $484.33 / $507.92
| Professional | | $453.12 | $484.33 | $507.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $148.91 / $159.16 / $168.56
| Professional | 26 | $148.91 | $159.16 | $168.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $469.68 / $469.68 / $469.68
| Facility | 26 | $469.68 | $469.68 | $469.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.49 / $596.92 / $885.27
| Professional | | $348.49 | $596.92 | $885.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.90 / $186.78 / $240.47
| Professional | 26 | $98.90 | $186.78 | $240.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $792.40 / $792.40 / $792.40
| Facility | 26 | $792.40 | $792.40 | $792.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.23 / $612.87 / $2,854.54
| Professional | | $398.23 | $612.87 | $2,854.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $105.27 / $172.63 / $536.20
| Professional | 26 | $105.27 | $172.63 | $536.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $275.52 / $283.55 / $469.68
| Facility | 26 | $275.52 | $283.55 | $469.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.73 / $632.91 / $865.00
| Professional | | $490.73 | $632.91 | $865.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.60 / $607.09 / $765.83
| Professional | | $367.60 | $607.09 | $765.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.67 / $170.08 / $212.03
| Professional | 26 | $104.67 | $170.08 | $212.03 |