- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $67.68 / $368.70 / $621.48
| Facility | 26 | $67.68 | $368.70 | $621.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.33 / $400.33 / $898.00
| Professional | | $400.33 | $400.33 | $898.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.56 / $67.56 / $413.60
| Professional | 26 | $67.56 | $67.56 | $413.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.89 / $784.01 / $803.62
| Professional | | $740.89 | $784.01 | $803.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $126.09 / $133.44 / $136.78
| Professional | 26 | $126.09 | $133.44 | $136.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $393.78 / $393.78 / $393.78
| Facility | 26 | $393.78 | $393.78 | $393.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.36 / $983.59 / $1,229.48
| Professional | | $794.36 | $983.59 | $1,229.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $135.19 / $161.35 / $201.68
| Professional | 26 | $135.19 | $161.35 | $201.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $661.44 / $661.44 / $661.44
| Facility | 26 | $661.44 | $661.44 | $661.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.28 / $848.70 / $2,775.50
| Professional | | $649.28 | $848.70 | $2,775.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.19 / $143.22 / $439.61
| Professional | 26 | $107.19 | $143.22 | $439.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $233.11 / $239.90 / $393.78
| Facility | 26 | $233.11 | $239.90 | $393.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.45 / $915.95 / $1,230.38
| Professional | | $765.45 | $915.95 | $1,230.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.00 / $766.50 / $1,179.00
| Professional | | $700.00 | $766.50 | $1,179.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.41 / $871.26 / $1,053.41
| Professional | | $519.41 | $871.26 | $1,053.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.75 / $139.35 / $178.65
| Professional | 26 | $85.75 | $139.35 | $178.65 |