- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.61 / $66.61 / $66.61
| Facility | 26 | $66.61 | $66.61 | $66.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.08 / $363.92 / $1,813.66
| Professional | | $280.08 | $363.92 | $1,813.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.49 / $66.48 / $332.00
| Professional | 26 | $55.49 | $66.48 | $332.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.42 / $54.42 / $54.42
| Facility | 26 | $54.42 | $54.42 | $54.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.79 / $828.14 / $1,188.34
| Professional | | $544.79 | $828.14 | $1,188.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $105.23 / $156.97 / $225.24
| Professional | 26 | $105.23 | $156.97 | $225.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $159.19 / $225.75 / $543.07
| Facility | 26 | $159.19 | $225.75 | $543.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.67 / $649.67 / $993.02
| Professional | | $516.67 | $649.67 | $993.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.39 / $122.46 / $187.18
| Professional | 26 | $97.39 | $122.46 | $187.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.34 / $206.39 / $427.61
| Facility | 26 | $125.34 | $206.39 | $427.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.56 / $511.56 / $927.86
| Professional | | $511.56 | $511.56 | $927.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $96.43 / $96.43 / $174.90
| Professional | 26 | $96.43 | $96.43 | $174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.64 / $684.92 / $1,351.37
| Professional | | $404.64 | $684.92 | $1,351.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.45 / $124.26 / $245.55
| Professional | 26 | $75.45 | $124.26 | $245.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.94 / $682.09 / $1,155.31
| Professional | | $378.94 | $682.09 | $1,155.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.45 / $121.85 / $212.35
| Professional | 26 | $75.45 | $121.85 | $212.35 |