- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.45 / $31.45 / $115.08
| Facility | 26 | $31.45 | $31.45 | $115.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.03 / $95.37 / $123.77
| Professional | | $70.03 | $95.37 | $123.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.45 / $39.69 / $48.50
| Professional | 26 | $31.45 | $39.69 | $48.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.10 / $100.95 / $207.39
| Facility | 26 | $96.10 | $100.95 | $207.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.13 / $166.24 / $703.95
| Professional | | $105.13 | $166.24 | $703.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.03 / $61.98 / $282.35
| Professional | 26 | $38.03 | $61.98 | $282.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.83 / $174.40 / $333.93
| Professional | | $110.83 | $174.40 | $333.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.84 / $68.18 / $120.82
| Professional | 26 | $43.84 | $68.18 | $120.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.89 / $109.63 / $205.37
| Professional | | $53.89 | $109.63 | $205.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.22 / $272.02 / $358.84
| Professional | | $137.22 | $272.02 | $358.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.20 / $103.12 / $133.88
| Professional | 26 | $51.20 | $103.12 | $133.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $98.32 / $207.39 / $207.39
| Facility | 26 | $98.32 | $207.39 | $207.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.17 / $174.96 / $703.95
| Professional | | $114.17 | $174.96 | $703.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.26 / $65.51 / $282.35
| Professional | 26 | $41.26 | $65.51 | $282.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.35 / $150.11 / $258.54
| Professional | | $109.35 | $150.11 | $258.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.03 / $53.98 / $113.04
| Professional | 26 | $38.03 | $53.98 | $113.04 |