- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $89.76 / $272.18 / $458.78
| Facility | 26 | $89.76 | $272.18 | $458.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.61 / $160.61 / $1,055.96
| Professional | | $160.61 | $160.61 | $1,055.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.34 / $88.96 / $387.90
| Professional | 26 | $49.34 | $88.96 | $387.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $195.00 / $195.00 / $195.00
| Professional | 26 | $195.00 | $195.00 | $195.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.82 / $315.13 / $323.01
| Professional | | $294.82 | $315.13 | $323.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $155.94 / $173.69 / $178.03
| Professional | 26 | $155.94 | $173.69 | $178.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $512.58 / $512.58 / $512.58
| Facility | 26 | $512.58 | $512.58 | $512.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.28 / $366.51 / $579.64
| Professional | | $164.28 | $366.51 | $579.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.70 / $199.25 / $261.80
| Professional | 26 | $84.70 | $199.25 | $261.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $423.87 / $423.87 / $423.87
| Facility | 26 | $423.87 | $423.87 | $423.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.23 / $340.49 / $3,093.52
| Professional | | $209.23 | $340.49 | $3,093.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.06 / $155.57 / $676.01
| Professional | 26 | $76.06 | $155.57 | $676.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $175.33 / $180.43 / $512.58
| Facility | 26 | $175.33 | $180.43 | $512.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.47 / $364.34 / $632.87
| Professional | | $287.47 | $364.34 | $632.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.23 / $340.49 / $438.24
| Professional | | $209.23 | $340.49 | $438.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.32 / $177.48 / $233.51
| Professional | 26 | $97.32 | $177.48 | $233.51 |