- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $68.56 / $68.56 / $68.56
| Facility | 26 | $68.56 | $68.56 | $68.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.08 / $97.13 / $126.13
| Professional | | $83.08 | $97.13 | $126.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.95 / $68.56 / $127.02
| Professional | 26 | $58.95 | $68.56 | $127.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.59 / $57.59 / $57.59
| Facility | 26 | $57.59 | $57.59 | $57.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.75 / $234.32 / $331.99
| Professional | | $156.75 | $234.32 | $331.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $110.71 / $166.84 / $234.62
| Professional | 26 | $110.71 | $166.84 | $234.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $167.61 / $237.69 / $571.79
| Facility | 26 | $167.61 | $237.69 | $571.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.60 / $184.33 / $346.62
| Professional | | $146.60 | $184.33 | $346.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $103.03 / $129.55 / $243.60
| Professional | 26 | $103.03 | $129.55 | $243.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $136.26 / $217.31 / $450.24
| Facility | 26 | $136.26 | $217.31 | $450.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.15 / $171.60 / $293.01
| Professional | | $145.15 | $171.60 | $293.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.01 / $120.60 / $205.92
| Professional | 26 | $102.01 | $120.60 | $205.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.34 / $209.63 / $463.83
| Professional | | $114.34 | $209.63 | $463.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.58 / $142.27 / $337.63
| Professional | 26 | $83.58 | $142.27 | $337.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.34 / $190.56 / $339.79
| Professional | | $114.34 | $190.56 | $339.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.90 / $139.30 / $248.39
| Professional | 26 | $79.90 | $139.30 | $248.39 |