- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.98 / $52.98 / $120.90
| Facility | 26 | $52.98 | $52.98 | $120.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.22 / $96.44 / $233.00
| Professional | | $79.22 | $96.44 | $233.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.95 / $52.98 / $120.90
| Professional | 26 | $40.95 | $52.98 | $120.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.59 / $72.59 / $72.59
| Professional | | $72.59 | $72.59 | $72.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.44 / $100.00 / $187.77
| Professional | | $79.44 | $100.00 | $187.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.26 / $52.00 / $91.43
| Professional | 26 | $42.26 | $52.00 | $91.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.00 / $116.16 / $210.36
| Professional | | $99.00 | $116.16 | $210.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.90 / $62.14 / $115.56
| Professional | 26 | $51.90 | $62.14 | $115.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.92 / $69.00 / $82.04
| Facility | 26 | $54.92 | $69.00 | $82.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.51 / $46.25 / $58.92
| Professional | | $45.51 | $46.25 | $58.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.98 / $55.69 / $141.14
| Professional | | $29.98 | $55.69 | $141.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.44 / $112.94 / $218.06
| Professional | | $75.44 | $112.94 | $218.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.20 / $59.99 / $118.89
| Professional | 26 | $43.20 | $59.99 | $118.89 |