- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.06 / $7.06 / $25.14
| Facility | 26 | $7.06 | $7.06 | $25.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.39 / $31.19 / $44.04
| Professional | | $24.39 | $31.19 | $44.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.06 / $8.46 / $13.32
| Professional | 26 | $7.06 | $8.46 | $13.32 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.44 / $21.47 / $100.00
| Facility | 26 | $20.44 | $21.47 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.68 / $48.49 / $233.00
| Professional | | $28.68 | $48.49 | $233.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.18 / $13.51 / $97.41
| Professional | 26 | $8.18 | $13.51 | $97.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.94 / $16.62 / $25.40
| Professional | 26 | $9.94 | $16.62 | $25.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.41 / $54.76 / $111.53
| Professional | | $31.41 | $54.76 | $111.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.25 / $14.85 / $25.81
| Professional | 26 | $9.25 | $14.85 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.15 / $38.19 / $66.79
| Professional | | $11.15 | $38.19 | $66.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.86 / $86.53 / $114.30
| Professional | | $35.86 | $86.53 | $114.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.65 / $21.02 / $27.85
| Professional | 26 | $10.65 | $21.02 | $27.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.68 / $13.68 / $13.68
| Professional | | $13.68 | $13.68 | $13.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.47 / $100.00 / $100.00
| Facility | 26 | $20.47 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.22 / $50.35 / $233.00
| Professional | | $32.22 | $50.35 | $233.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $14.07 / $97.41
| Professional | 26 | $8.91 | $14.07 | $97.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.85 / $47.11 / $106.95
| Professional | | $30.85 | $47.11 | $106.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.82 / $12.13 / $21.47
| Professional | 26 | $8.82 | $12.13 | $21.47 |