- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.60 / $58.60 / $92.34
| Facility | 26 | $58.60 | $58.60 | $92.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.79 / $346.06 / $760.39
| Professional | | $275.79 | $346.06 | $760.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.96 / $57.91 / $127.48
| Professional | 26 | $50.96 | $57.91 | $127.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.58 / $474.58 / $474.58
| Professional | | $474.58 | $474.58 | $474.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.02 / $512.95 / $1,087.63
| Professional | | $271.02 | $512.95 | $1,087.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.02 / $86.08 / $178.66
| Professional | 26 | $55.02 | $86.08 | $178.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $128.97 / $128.97 / $128.97
| Facility | 26 | $128.97 | $128.97 | $128.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.19 / $415.82 / $2,222.29
| Professional | | $255.19 | $415.82 | $2,222.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.77 / $77.09 / $774.69
| Professional | 26 | $59.77 | $77.09 | $774.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.45 / $403.99 / $686.87
| Professional | | $251.45 | $403.99 | $686.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.33 / $73.00 / $140.79
| Professional | 26 | $59.33 | $73.00 | $140.79 |