- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $301.05 / $301.05 / $548.42
| Facility | 26 | $301.05 | $301.05 | $548.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.37 / $1,003.38 / $1,711.25
| Professional | | $1,003.37 | $1,003.38 | $1,711.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $301.05 / $301.05 / $569.92
| Professional | 26 | $301.05 | $301.05 | $569.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.71 / $1,538.08 / $1,688.83
| Professional | | $451.71 | $1,538.08 | $1,688.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.77 / $1,619.45 / $1,902.65
| Professional | | $1,200.77 | $1,619.45 | $1,902.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $374.76 / $506.65 / $639.95
| Professional | 26 | $374.76 | $506.65 | $639.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,693.76 / $3,363.92 / $3,363.92
| Facility | 26 | $2,693.76 | $3,363.92 | $3,363.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.67 / $1,514.97 / $8,224.96
| Professional | | $1,123.67 | $1,514.97 | $8,224.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $325.01 / $489.46 / $2,275.66
| Professional | 26 | $325.01 | $489.46 | $2,275.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.23 / $1,403.36 / $2,092.67
| Professional | | $1,097.23 | $1,403.36 | $2,092.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $321.50 / $450.26 / $654.15
| Professional | 26 | $321.50 | $450.26 | $654.15 |