- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $272.99 / $475.00 / $952.74
| Facility | 26 | $272.99 | $475.00 | $952.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.04 / $888.75 / $3,730.40
| Professional | | $719.04 | $888.75 | $3,730.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.97 / $1,393.22 / $1,629.90
| Professional | | $885.97 | $1,393.22 | $1,629.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $320.77 / $320.77 / $320.77
| Facility | 26 | $320.77 | $320.77 | $320.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.03 / $1,091.69 / $1,685.62
| Professional | | $744.03 | $1,091.69 | $1,685.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.46 / $1,236.93 / $1,422.89
| Professional | | $1,034.46 | $1,236.93 | $1,422.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.76 / $335.76 / $1,126.17
| Professional | | $335.76 | $335.76 | $1,126.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $272.99 / $526.28 / $1,078.31
| Facility | 26 | $272.99 | $526.28 | $1,078.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.84 / $960.60 / $2,636.17
| Professional | | $761.84 | $960.60 | $2,636.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.81 / $1,134.61 / $1,709.24
| Professional | | $423.81 | $1,134.61 | $1,709.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $320.77 / $320.77 / $320.77
| Facility | 26 | $320.77 | $320.77 | $320.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.18 / $1,093.08 / $1,780.99
| Professional | | $745.18 | $1,093.08 | $1,780.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $276.69 / $276.69 / $303.77
| Facility | 26 | $276.69 | $276.69 | $303.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $844.81 / $857.65 / $957.58
| Professional | | $844.81 | $857.65 | $957.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.19 / $1,026.10 / $1,693.03
| Professional | | $789.19 | $1,026.10 | $1,693.03 |