- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.77 / $312.30 / $424.26
| Professional | | $292.77 | $312.30 | $424.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.14 / $59.88 / $142.83
| Professional | 26 | $56.14 | $59.88 | $142.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.20 / $290.20 / $290.20
| Professional | | $290.20 | $290.20 | $290.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $136.33 / $136.33 / $136.33
| Professional | 26 | $136.33 | $136.33 | $136.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.56 / $715.88 / $974.50
| Professional | | $320.56 | $715.88 | $974.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.20 / $101.80 / $138.10
| Professional | 26 | $65.20 | $101.80 | $138.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.15 / $37.57 / $105.59
| Facility | 26 | $35.15 | $37.57 | $105.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.69 / $284.67 / $738.14
| Professional | | $166.69 | $284.67 | $738.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.75 / $63.57 / $154.25
| Professional | 26 | $35.75 | $63.57 | $154.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $177.61 / $340.61 / $375.20
| Facility | 26 | $177.61 | $340.61 | $375.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,261.22 / $3,261.22 / $4,153.64
| Professional | | $3,261.22 | $3,261.22 | $4,153.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $665.00 / $665.00 / $665.00
| Professional | 26 | $665.00 | $665.00 | $665.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.80 / $393.05 / $865.85
| Professional | | $214.80 | $393.05 | $865.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.70 / $69.53 / $140.44
| Professional | 26 | $42.70 | $69.53 | $140.44 |