- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $126.00 / $161.04 / $398.16
| Facility | 26 | $126.00 | $161.04 | $398.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.05 / $425.00 / $1,068.00
| Professional | | $289.05 | $425.00 | $1,068.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.98 / $266.98 / $266.98
| Professional | | $266.98 | $266.98 | $266.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.50 / $283.82 / $578.90
| Professional | | $273.50 | $283.82 | $578.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | 26 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.99 / $465.91 / $842.90
| Professional | | $245.99 | $465.91 | $842.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.02 / $432.37 / $1,087.18
| Professional | | $327.02 | $432.37 | $1,087.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.03 / $354.03 / $555.53
| Professional | | $354.03 | $354.03 | $555.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $126.00 / $164.51 / $403.20
| Facility | 26 | $126.00 | $164.51 | $403.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.72 / $425.00 / $1,320.50
| Professional | | $291.72 | $425.00 | $1,320.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.05 / $502.07 / $681.20
| Professional | | $157.05 | $502.07 | $681.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | 26 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.02 / $453.13 / $815.33
| Professional | | $258.02 | $453.13 | $815.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $108.95 / $108.95 / $128.12
| Facility | 26 | $108.95 | $108.95 | $128.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.19 / $279.98 / $491.45
| Professional | | $276.19 | $279.98 | $491.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.10 / $403.14 / $645.90
| Professional | | $279.10 | $403.14 | $645.90 |