- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.00 / $294.64 / $325.66
| Facility | 26 | $55.00 | $294.64 | $325.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.65 / $275.00 / $405.50
| Professional | | $201.65 | $275.00 | $405.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.00 / $60.67 / $98.00
| Professional | 26 | $55.00 | $60.67 | $98.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.52 / $148.52 / $148.52
| Professional | | $148.52 | $148.52 | $148.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.08 / $48.65 / $54.97
| Professional | 26 | $45.08 | $48.65 | $54.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.44 / $411.60 / $595.26
| Professional | | $199.44 | $411.60 | $595.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.84 / $93.12 / $147.13
| Professional | 26 | $56.84 | $93.12 | $147.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $62.03 / $62.03 / $68.70
| Facility | 26 | $62.03 | $62.03 | $68.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.56 / $390.25 / $635.24
| Professional | | $175.56 | $390.25 | $635.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.00 / $88.80 / $140.61
| Professional | 26 | $51.00 | $88.80 | $140.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $546.72 / $546.72 / $561.91
| Facility | 26 | $546.72 | $546.72 | $561.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,293.84 / $2,362.66 / $2,362.66
| Professional | | $2,293.84 | $2,362.66 | $2,362.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $523.40 / $523.40 / $523.40
| Professional | 26 | $523.40 | $523.40 | $523.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.15 / $358.17 / $540.19
| Professional | | $215.15 | $358.17 | $540.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.41 / $74.58 / $130.85
| Professional | 26 | $60.41 | $74.58 | $130.85 |