- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | 26 | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $630.96 / $977.24
| Professional | | $478.63 | $630.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $165.96 / $208.93 / $512.86
| Professional | 26 | $165.96 | $208.93 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $151.36 / $173.78 / $173.78
| Facility | 26 | $151.36 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,445.44 / $2,187.76
| Professional | | $1,000.00 | $1,445.44 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $331.13 / $478.63 / $724.44
| Professional | 26 | $331.13 | $478.63 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $524.81 / $741.31 / $1,778.28
| Facility | 26 | $524.81 | $741.31 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,202.26 / $1,949.84
| Professional | | $954.99 | $1,202.26 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $309.03 / $389.05 / $630.96
| Professional | 26 | $309.03 | $389.05 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $575.44 / $724.44 / $1,380.38
| Facility | 26 | $575.44 | $724.44 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $1,479.11
| Professional | | $933.25 | $933.25 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $302.00 / $302.00 / $478.63
| Professional | 26 | $302.00 | $302.00 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,122.02 / $2,187.76
| Professional | | $676.08 | $1,122.02 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $223.87 / $371.54 / $776.25
| Professional | 26 | $223.87 | $371.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,148.15 / $2,041.74
| Professional | | $724.44 | $1,148.15 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $239.88 / $380.19 / $676.08
| Professional | 26 | $239.88 | $380.19 | $676.08 |