- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.88 / $60.88 / $60.88
| Facility | 26 | $60.88 | $60.88 | $60.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.23 / $389.17 / $1,135.25
| Professional | | $318.23 | $389.17 | $1,135.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.96 / $60.37 / $149.55
| Professional | 26 | $50.96 | $60.37 | $149.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.22 / $47.22 / $47.22
| Facility | 26 | $47.22 | $47.22 | $47.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.83 / $957.66 / $1,234.09
| Professional | | $508.83 | $957.66 | $1,234.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.06 / $152.03 / $195.91
| Professional | 26 | $81.06 | $152.03 | $195.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $138.97 / $197.08 / $474.11
| Facility | 26 | $138.97 | $197.08 | $474.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.82 / $978.44 / $1,523.62
| Professional | | $605.82 | $978.44 | $1,523.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.82 / $151.52 / $235.95
| Professional | 26 | $93.82 | $151.52 | $235.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $126.27 / $180.18 / $373.31
| Facility | 26 | $126.27 | $180.18 | $373.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.82 / $910.74 / $1,376.70
| Professional | | $599.82 | $910.74 | $1,376.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $92.89 / $141.04 / $213.20
| Professional | 26 | $92.89 | $141.04 | $213.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.80 / $793.33 / $2,222.29
| Professional | | $368.80 | $793.33 | $2,222.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.11 / $125.74 / $774.69
| Professional | 26 | $65.11 | $125.74 | $774.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.69 / $692.33 / $1,233.21
| Professional | | $360.69 | $692.33 | $1,233.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.71 / $116.01 / $213.20
| Professional | 26 | $63.71 | $116.01 | $213.20 |