- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Facility | 26 | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $446.68 / $1,202.26
| Professional | | $323.59 | $446.68 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $147.91 / $467.74
| Professional | 26 | $56.23 | $147.91 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,258.93 / $1,698.24
| Professional | | $758.58 | $1,258.93 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $123.03 / $190.55 / $257.04
| Professional | 26 | $123.03 | $190.55 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.89 / $562.34 / $676.08
| Facility | 26 | $125.89 | $562.34 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $831.76 / $1,071.52
| Professional | | $660.69 | $831.76 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $125.89 / $158.49
| Professional | 26 | $100.00 | $125.89 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $524.81 / $524.81
| Facility | 26 | $97.72 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $954.99
| Professional | | $660.69 | $660.69 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $97.72 / $158.49
| Professional | 26 | $97.72 | $97.72 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Facility | 26 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $707.95 / $3,235.94
| Professional | | $234.42 | $707.95 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $194.98 / $389.05
| Professional | 26 | $63.10 | $194.98 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $707.95 / $1,513.56
| Professional | | $281.84 | $707.95 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $144.54 / $251.19
| Professional | 26 | $63.10 | $144.54 | $251.19 |