- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.00 / $85.25 / $325.66
| Facility | 26 | $55.00 | $85.25 | $325.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.60 / $275.00 / $399.62
| Professional | | $203.60 | $275.00 | $399.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.00 / $60.39 / $98.00
| Professional | 26 | $55.00 | $60.39 | $98.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.33 / $46.33 / $48.90
| Professional | 26 | $46.33 | $46.33 | $48.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.93 / $413.06 / $597.61
| Professional | | $198.93 | $413.06 | $597.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.70 / $93.12 / $147.13
| Professional | 26 | $56.70 | $93.12 | $147.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $62.03 / $62.03 / $69.05
| Facility | 26 | $62.03 | $62.03 | $69.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.56 / $392.78 / $635.24
| Professional | | $177.56 | $392.78 | $635.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.27 / $88.55 / $141.35
| Professional | 26 | $51.27 | $88.55 | $141.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $549.76 / $549.76 / $565.04
| Facility | 26 | $549.76 | $549.76 | $565.04 |
- 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
- $216.64 / $354.03 / $529.73
| Professional | | $216.64 | $354.03 | $529.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.76 / $74.48 / $134.47
| Professional | 26 | $59.76 | $74.48 | $134.47 |