- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.65 / $71.65 / $71.65
| Facility | 26 | $71.65 | $71.65 | $71.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.69 / $454.22 / $663.16
| Professional | | $435.69 | $454.22 | $663.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.65 / $74.02 / $154.00
| Professional | 26 | $71.65 | $74.02 | $154.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $59.60 / $59.60 / $59.60
| Facility | 26 | $59.60 | $59.60 | $59.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.46 / $1,062.80 / $1,496.88
| Professional | | $683.46 | $1,062.80 | $1,496.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $115.10 / $174.08 / $245.18
| Professional | 26 | $115.10 | $174.08 | $245.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $173.51 / $246.05 / $591.91
| Facility | 26 | $173.51 | $246.05 | $591.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.95 / $817.26 / $1,467.66
| Professional | | $649.95 | $817.26 | $1,467.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.62 / $134.06 / $252.09
| Professional | 26 | $106.62 | $134.06 | $252.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $141.05 / $224.95 / $466.08
| Facility | 26 | $141.05 | $224.95 | $466.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.51 / $761.69 / $1,299.07
| Professional | | $643.51 | $761.69 | $1,299.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $105.56 / $124.95 / $213.10
| Professional | 26 | $105.56 | $124.95 | $213.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.38 / $945.54 / $2,775.50
| Professional | | $531.38 | $945.54 | $2,775.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.65 / $149.41 / $439.61
| Professional | 26 | $89.65 | $149.41 | $439.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.70 / $871.26 / $1,685.99
| Professional | | $509.70 | $871.26 | $1,685.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.98 / $149.41 / $262.81
| Professional | 26 | $84.98 | $149.41 | $262.81 |