- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.84 / $64.57 / $147.91
| Facility | 26 | $28.84 | $64.57 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $281.84 / $1,412.54
| Professional | | $186.21 | $281.84 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $43.65 / $204.17
| Professional | 26 | $26.92 | $43.65 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $91.20 / $234.42
| Facility | 26 | $41.69 | $91.20 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $331.13 / $1,778.28
| Professional | | $190.55 | $331.13 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.54 / $46.77 / $257.04
| Professional | 26 | $27.54 | $46.77 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $72.44 / $104.71
| Professional | 26 | $60.26 | $72.44 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $436.52 / $891.25
| Professional | | $229.09 | $436.52 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $63.10 / $112.20
| Professional | 26 | $45.71 | $63.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $338.84 / $524.81
| Professional | | $50.12 | $338.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $371.54 / $707.95
| Professional | | $269.15 | $371.54 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $45.71 / $95.50
| Professional | 26 | $37.15 | $45.71 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $57.54 / $57.54
| Professional | | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $91.20 / $234.42
| Facility | 26 | $41.69 | $91.20 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $323.59 / $1,778.28
| Professional | | $190.55 | $323.59 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.54 / $46.77 / $257.04
| Professional | 26 | $27.54 | $46.77 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $389.05 / $912.01
| Professional | | $190.55 | $389.05 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $53.70 / $114.82
| Professional | 26 | $38.02 | $53.70 | $114.82 |