- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.43 / $51.43 / $51.43
| Facility | 26 | $51.43 | $51.43 | $51.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.63 / $252.60 / $601.96
| Professional | | $229.63 | $252.60 | $601.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.43 / $60.34 / $190.00
| Professional | 26 | $51.43 | $60.34 | $190.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.46 / $408.02 / $566.95
| Professional | | $249.46 | $408.02 | $566.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.14 / $82.93 / $111.72
| Professional | 26 | $49.14 | $82.93 | $111.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.79 / $537.87 / $722.95
| Professional | | $298.79 | $537.87 | $722.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.43 / $113.86 / $139.58
| Professional | 26 | $61.43 | $113.86 | $139.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $242.19 / $242.19 / $242.19
| Facility | 26 | $242.19 | $242.19 | $242.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.49 / $434.44 / $1,659.46
| Professional | | $278.49 | $434.44 | $1,659.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.76 / $104.15 / $337.70
| Professional | 26 | $66.76 | $104.15 | $337.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.71 / $525.09 / $652.54
| Professional | | $331.71 | $525.09 | $652.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.47 / $292.27 / $564.73
| Professional | | $53.47 | $292.27 | $564.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.49 / $456.80 / $598.03
| Professional | | $278.49 | $456.80 | $598.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.76 / $104.15 / $131.01
| Professional | 26 | $66.76 | $104.15 | $131.01 |