- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.34 / $71.34 / $71.34
| Facility | 26 | $71.34 | $71.34 | $71.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.83 / $358.38 / $454.55
| Professional | | $274.83 | $358.38 | $454.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.57 / $71.34 / $432.25
| Professional | 26 | $55.57 | $71.34 | $432.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.67 / $1,148.34 / $1,769.32
| Professional | | $744.67 | $1,148.34 | $1,769.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $116.09 / $176.25 / $271.55
| Professional | 26 | $116.09 | $176.25 | $271.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $123.98 / $537.21 / $643.64
| Facility | 26 | $123.98 | $537.21 | $643.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.24 / $830.20 / $1,051.50
| Professional | | $660.24 | $830.20 | $1,051.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $99.04 / $124.53 / $157.72
| Professional | 26 | $99.04 | $124.53 | $157.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $97.62 / $506.80 / $506.80
| Facility | 26 | $97.62 | $506.80 | $506.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.70 / $653.70 / $935.25
| Professional | | $653.70 | $653.70 | $935.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.06 / $98.06 / $140.29
| Professional | 26 | $98.06 | $98.06 | $140.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $340.61 / $340.61 / $340.61
| Facility | 26 | $340.61 | $340.61 | $340.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.69 / $708.34 / $3,261.22
| Professional | | $279.69 | $708.34 | $3,261.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.91 / $197.01 / $665.00
| Professional | 26 | $75.91 | $197.01 | $665.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.04 / $629.09 / $1,035.09
| Professional | | $280.04 | $629.09 | $1,035.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.35 / $95.71 / $209.49
| Professional | 26 | $63.35 | $95.71 | $209.49 |