- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $204.17 / $204.17 / $354.81
| Facility | 26 | $204.17 | $204.17 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $602.56 / $954.99
| Professional | | $478.63 | $602.56 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $173.78 / $204.17 / $338.84
| Professional | 26 | $173.78 | $204.17 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,258.93 / $1,548.82
| Professional | | $1,071.52 | $1,258.93 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $354.81 / $416.87 / $512.86
| Professional | 26 | $354.81 | $416.87 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,023.29 / $1,621.81
| Professional | | $676.08 | $1,023.29 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $218.78 / $338.84 / $524.81
| Professional | 26 | $218.78 | $338.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,148.15 / $3,801.89
| Professional | | $616.60 | $1,148.15 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $204.17 / $371.54 / $1,230.27
| Professional | 26 | $204.17 | $371.54 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,122.02 / $1,584.89
| Professional | | $575.44 | $1,122.02 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $194.98 / $371.54 / $524.81
| Professional | 26 | $194.98 | $371.54 | $524.81 |