- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $149.33 / $210.71 / $210.71
| Facility | 26 | $149.33 | $210.71 | $210.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.44 / $244.82 / $385.52
| Professional | | $165.44 | $244.82 | $385.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.70 / $385.52 / $1,424.44
| Professional | | $226.70 | $385.52 | $1,424.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $261.32 / $305.38 / $468.46
| Facility | 26 | $261.32 | $305.38 | $468.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.84 / $556.52 / $1,020.33
| Professional | | $252.84 | $556.52 | $1,020.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $454.15 / $454.15 / $454.15
| Facility | 26 | $454.15 | $454.15 | $454.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.47 / $391.61 / $1,682.32
| Professional | | $215.47 | $391.61 | $1,682.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.50 / $210.05 / $505.66
| Professional | | $83.50 | $210.05 | $505.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.01 / $614.48 / $905.30
| Professional | | $252.01 | $614.48 | $905.30 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $113.41 / $454.15 / $454.15
| Facility | 26 | $113.41 | $454.15 | $454.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.17 / $1,206.00 / $1,682.32
| Professional | | $378.17 | $1,206.00 | $1,682.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.87 / $1,599.94 / $1,599.94
| Professional | | $451.87 | $1,599.94 | $1,599.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.23 / $332.72 / $898.49
| Professional | | $232.23 | $332.72 | $898.49 |