- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $144.54 / $204.17 / $812.83
| Facility | 26 | $144.54 | $204.17 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $616.60 / $1,778.28
| Professional | | $426.58 | $616.60 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $144.54 / $208.93 / $575.44
| Professional | 26 | $144.54 | $208.93 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $223.87 / $489.78 / $1,230.27
| Facility | 26 | $223.87 | $489.78 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $776.25 / $2,089.30
| Professional | | $489.78 | $776.25 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $154.88 / $239.88 / $645.65
| Professional | 26 | $154.88 | $239.88 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $234.42 / $398.11 / $616.60
| Professional | 26 | $234.42 | $398.11 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,148.15 / $1,862.09
| Professional | | $724.44 | $1,148.15 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $229.09 / $371.54 / $588.84
| Professional | 26 | $229.09 | $371.54 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $645.65 / $1,174.90
| Professional | | $275.42 | $645.65 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,023.29 / $1,737.80
| Professional | | $630.96 | $1,023.29 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $204.17 / $288.40 / $537.03
| Professional | 26 | $204.17 | $288.40 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Professional | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $223.87 / $489.78 / $1,230.27
| Facility | 26 | $223.87 | $489.78 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $2,089.30
| Professional | | $489.78 | $794.33 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $154.88 / $239.88 / $660.69
| Professional | 26 | $154.88 | $239.88 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $851.14 / $1,949.84
| Professional | | $645.65 | $851.14 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $204.17 / $269.15 / $562.34
| Professional | 26 | $204.17 | $269.15 | $562.34 |