- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.00 / $85.25 / $314.52
| Facility | 26 | $55.00 | $85.25 | $314.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.82 / $275.00 / $413.03
| Professional | | $230.82 | $275.00 | $413.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.46 / $55.00 / $98.00
| Professional | 26 | $52.46 | $55.00 | $98.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.93 / $66.01 / $66.01
| Professional | 26 | $43.93 | $66.01 | $66.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.11 / $428.38 / $625.78
| Professional | | $217.11 | $428.38 | $625.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.74 / $89.34 / $144.97
| Professional | 26 | $53.74 | $89.34 | $144.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $59.91 / $59.91 / $65.64
| Facility | 26 | $59.91 | $59.91 | $65.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.43 / $384.91 / $632.14
| Professional | | $215.43 | $384.91 | $632.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.82 / $84.75 / $135.80
| Professional | 26 | $48.82 | $84.75 | $135.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $522.72 / $522.72 / $537.20
| Facility | 26 | $522.72 | $522.72 | $537.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,022.16 / $2,077.23 / $2,077.23
| Professional | | $2,022.16 | $2,077.23 | $2,077.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $394.61 / $394.61 / $456.90
| Professional | 26 | $394.61 | $394.61 | $456.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.57 / $346.47 / $564.44
| Professional | | $256.57 | $346.47 | $564.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.07 / $70.79 / $124.88
| Professional | 26 | $58.07 | $70.79 | $124.88 |