- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.38 / $23.41 / $139.19
| Facility | 26 | $22.38 | $23.41 | $139.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.88 / $196.00 / $1,156.81
| Professional | | $161.88 | $196.00 | $1,156.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.51 / $219.29 / $489.33
| Professional | | $174.51 | $219.29 | $489.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.19 / $247.99 / $524.54
| Professional | | $160.19 | $247.99 | $524.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.06 / $231.26 / $587.19
| Professional | | $157.06 | $231.26 | $587.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.52 / $240.26 / $324.35
| Professional | | $86.52 | $240.26 | $324.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.52 / $25.34 / $34.21
| Professional | 26 | $9.52 | $25.34 | $34.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.61 / $235.50 / $396.92
| Professional | | $178.61 | $235.50 | $396.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.82 / $30.29 / $53.15
| Professional | 26 | $20.82 | $30.29 | $53.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.17 / $122.00 / $122.00
| Facility | 26 | $71.17 | $122.00 | $122.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,203.75 / $1,203.75 / $1,519.80
| Professional | | $1,203.75 | $1,203.75 | $1,519.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.06 / $224.81 / $585.66
| Professional | | $157.06 | $224.81 | $585.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.65 / $665.65 / $665.65
| Professional | | $665.65 | $665.65 | $665.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.78 / $194.33 / $267.20
| Professional | | $129.78 | $194.33 | $267.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.22 / $201.74 / $604.04
| Professional | | $135.22 | $201.74 | $604.04 |