- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $257.04 / $257.04 / $870.96
| Facility | 26 | $257.04 | $257.04 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $302.00 / $478.63
| Professional | | $257.04 | $302.00 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $467.74 / $1,318.26
| Professional | | $275.42 | $467.74 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $616.60 / $724.44 / $1,148.15
| Facility | 26 | $616.60 | $724.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $831.76 / $1,023.29
| Professional | | $436.52 | $831.76 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $831.76
| Professional | | $512.86 | $676.08 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $549.54 / $1,071.52 / $1,071.52
| Facility | 26 | $549.54 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $575.44 / $3,548.13
| Professional | | $302.00 | $575.44 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $331.13
| Professional | | $32.36 | $33.11 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $660.69 / $1,380.38
| Professional | | $354.81 | $660.69 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $549.54 / $1,479.11 / $1,479.11
| Facility | 26 | $549.54 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $3,548.13
| Professional | | $436.52 | $1,412.54 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,288.25 / $1,905.46
| Professional | | $954.99 | $1,288.25 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $478.63 / $977.24
| Professional | | $288.40 | $478.63 | $977.24 |