- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.87 / $123.12 / $534.04
| Professional | | $104.87 | $123.12 | $534.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.95 / $70.39 / $386.69
| Professional | 26 | $58.95 | $70.39 | $386.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $398.86 / $398.86 / $398.86
| Facility | 26 | $398.86 | $398.86 | $398.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.04 / $139.47 / $396.09
| Professional | | $66.04 | $139.47 | $396.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.06 / $98.54 / $280.98
| Professional | 26 | $46.06 | $98.54 | $280.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.53 / $139.47 / $396.09
| Professional | | $124.53 | $139.47 | $396.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.35 / $98.54 / $280.98
| Professional | 26 | $91.35 | $98.54 | $280.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.62 / $205.10 / $421.34
| Professional | | $96.62 | $205.10 | $421.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $96.67 / $298.89
| Professional | 26 | $69.18 | $96.67 | $298.89 |