- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.29 / $79.29 / $445.25
| Facility | 26 | $79.29 | $79.29 | $445.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.47 / $148.34 / $250.75
| Professional | | $132.47 | $148.34 | $250.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.63 / $82.56 / $126.12
| Professional | 26 | $77.63 | $82.56 | $126.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $126.93 / $126.93 / $145.80
| Professional | 26 | $126.93 | $126.93 | $145.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.74 / $271.60 / $427.08
| Professional | | $132.74 | $271.60 | $427.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.37 / $134.00 / $212.33
| Professional | 26 | $79.37 | $134.00 | $212.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $101.77 / $101.77 / $106.81
| Facility | 26 | $101.77 | $101.77 | $106.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.06 / $263.14 / $697.59
| Professional | | $137.06 | $263.14 | $697.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.01 / $123.12 / $207.21
| Professional | 26 | $79.01 | $123.12 | $207.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $217.15 / $445.22 / $445.22
| Facility | 26 | $217.15 | $445.22 | $445.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,391.09 / $3,492.82 / $3,492.82
| Professional | | $3,391.09 | $3,492.82 | $3,492.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $632.75 / $632.75 / $759.53
| Professional | 26 | $632.75 | $632.75 | $759.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.35 / $249.75 / $549.91
| Professional | | $160.35 | $249.75 | $549.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.15 / $109.97 / $198.86
| Professional | 26 | $87.15 | $109.97 | $198.86 |