- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.26 / $54.65 / $72.98
| Facility | 26 | $44.26 | $54.65 | $72.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.22 / $87.67 / $221.87
| Professional | | $79.22 | $87.67 | $221.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.95 / $45.04 / $114.03
| Professional | 26 | $40.95 | $45.04 | $114.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.50 / $80.50 / $104.30
| Professional | | $80.50 | $80.50 | $104.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.84 / $89.08 / $114.03
| Professional | 26 | $58.84 | $89.08 | $114.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.11 / $136.66 / $233.17
| Professional | | $101.11 | $136.66 | $233.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.63 / $75.16 / $121.33
| Professional | 26 | $53.63 | $75.16 | $121.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.21 / $58.00 / $117.77
| Facility | 26 | $55.21 | $58.00 | $117.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.01 / $122.01 / $209.31
| Professional | | $122.01 | $122.01 | $209.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $135.30 / $214.30
| Professional | | $10.00 | $135.30 | $214.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.39 / $119.73 / $231.91
| Professional | | $80.39 | $119.73 | $231.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.86 / $61.98 / $121.64
| Professional | 26 | $42.86 | $61.98 | $121.64 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $108.26 / $216.03 / $216.03
| Facility | 26 | $108.26 | $216.03 | $216.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.40 / $614.40 / $765.98
| Professional | | $614.40 | $614.40 | $765.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $314.88 / $314.88 / $408.38
| Professional | 26 | $314.88 | $314.88 | $408.38 |