- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $181.97 / $416.87 / $758.58
| Facility | 26 | $181.97 | $416.87 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $489.78 / $870.96
| Professional | | $371.54 | $489.78 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $117.49 / $177.83
| Professional | 26 | $70.79 | $117.49 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $630.96 / $1,122.02
| Professional | | $323.59 | $630.96 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.98 / $100.00 / $181.97
| Professional | 26 | $48.98 | $100.00 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $501.19 / $660.69
| Professional | | $446.68 | $501.19 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $79.43 / $104.71
| Professional | 26 | $70.79 | $79.43 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $478.63 / $758.58
| Professional | | $407.38 | $478.63 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $70.79 / $134.90
| Professional | 26 | $58.88 | $70.79 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $457.09 / $812.83
| Professional | | $323.59 | $457.09 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $69.18 / $125.89
| Professional | 26 | $51.29 | $69.18 | $125.89 |