- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.13 / $93.25 / $163.55
| Professional | | $85.13 | $93.25 | $163.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.72 / $28.07 / $79.88
| Professional | 26 | $25.72 | $28.07 | $79.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $183.07 / $183.07 / $183.07
| Facility | 26 | $183.07 | $183.07 | $183.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.61 / $232.11 / $1,357.00
| Professional | | $97.61 | $232.11 | $1,357.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.57 / $60.63 / $271.00
| Professional | 26 | $28.57 | $60.63 | $271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.05 / $147.36 / $193.10
| Professional | | $107.05 | $147.36 | $193.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.46 / $69.48 / $108.26
| Professional | 26 | $50.46 | $69.48 | $108.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.64 / $121.76 / $283.74
| Professional | | $69.64 | $121.76 | $283.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.32 / $35.19 / $62.97
| Professional | 26 | $19.32 | $35.19 | $62.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.97 / $177.77 / $296.11
| Professional | | $45.97 | $177.77 | $296.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.02 / $371.07 / $502.20
| Professional | | $197.02 | $371.07 | $502.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.06 / $84.87 / $114.86
| Professional | 26 | $45.06 | $84.87 | $114.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.50 / $174.50 / $174.50
| Professional | | $174.50 | $174.50 | $174.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $183.07 / $183.07 / $183.07
| Facility | 26 | $183.07 | $183.07 | $183.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.91 / $207.30 / $1,357.00
| Professional | | $83.91 | $207.30 | $1,357.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.40 / $58.56 / $271.00
| Professional | 26 | $27.40 | $58.56 | $271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.18 / $148.07 / $336.25
| Professional | | $79.18 | $148.07 | $336.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.33 / $41.98 / $91.54
| Professional | 26 | $26.33 | $41.98 | $91.54 |