- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.45 / $87.27 / $212.64
| Facility | 26 | $66.45 | $87.27 | $212.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.36 / $129.91 / $214.90
| Professional | | $111.36 | $129.91 | $214.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.19 / $135.11 / $246.79
| Professional | | $130.19 | $135.11 | $246.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $78.58 / $78.58 / $78.58
| Facility | 26 | $78.58 | $78.58 | $78.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.57 / $157.34 / $254.82
| Professional | | $99.57 | $157.34 | $254.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.12 / $177.20 / $222.69
| Professional | | $136.12 | $177.20 | $222.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.16 / $151.16 / $151.16
| Professional | | $151.16 | $151.16 | $151.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.45 / $99.51 / $217.29
| Facility | 26 | $66.45 | $99.51 | $217.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.94 / $153.09 / $380.59
| Professional | | $111.94 | $153.09 | $380.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.78 / $138.10 / $309.39
| Professional | | $74.78 | $138.10 | $309.39 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.90 / $78.58 / $78.58
| Facility | 26 | $34.90 | $78.58 | $78.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.60 / $156.29 / $254.82
| Professional | | $102.60 | $156.29 | $254.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.50 / $67.12 / $67.12
| Facility | 26 | $56.50 | $67.12 | $67.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.50 / $129.08 / $137.69
| Professional | | $113.50 | $129.08 | $137.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.22 / $141.31 / $233.47
| Professional | | $109.22 | $141.31 | $233.47 |