- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.12 / $136.50 / $241.37
| Professional | | $89.12 | $136.50 | $241.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.83 / $55.18 / $104.05
| Professional | 26 | $36.83 | $55.18 | $104.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $317.04 / $317.04 / $317.04
| Facility | 26 | $317.04 | $317.04 | $317.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.70 / $202.78 / $1,000.49
| Professional | | $100.70 | $202.78 | $1,000.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.83 / $83.54 / $415.79
| Professional | 26 | $46.83 | $83.54 | $415.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.17 / $96.92 / $130.88
| Professional | 26 | $70.17 | $96.92 | $130.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.08 / $114.01 / $287.37
| Professional | | $70.08 | $114.01 | $287.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.29 / $45.22 / $113.46
| Professional | 26 | $27.29 | $45.22 | $113.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.93 / $112.37 / $224.65
| Professional | | $63.93 | $112.37 | $224.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.97 / $290.31 / $392.96
| Professional | | $139.97 | $290.31 | $392.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.08 / $119.22 / $160.79
| Professional | 26 | $63.08 | $119.22 | $160.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.03 / $129.03 / $129.03
| Professional | | $129.03 | $129.03 | $129.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $317.04 / $317.04 / $317.04
| Facility | 26 | $317.04 | $317.04 | $317.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.70 / $193.00 / $1,000.49
| Professional | | $100.70 | $193.00 | $1,000.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.39 / $83.54 / $415.79
| Professional | 26 | $46.39 | $83.54 | $415.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.61 / $151.65 / $324.54
| Professional | | $94.61 | $151.65 | $324.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.46 / $62.43 / $129.03
| Professional | 26 | $43.46 | $62.43 | $129.03 |