- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.93 / $31.93 / $118.91
| Facility | 26 | $31.93 | $31.93 | $118.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.33 / $107.84 / $139.77
| Professional | | $76.33 | $107.84 | $139.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.93 / $38.10 / $46.99
| Professional | 26 | $31.93 | $38.10 | $46.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $92.82 / $161.40 / $193.99
| Facility | 26 | $92.82 | $161.40 | $193.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.61 / $256.60 / $2,022.91
| Professional | | $107.61 | $256.60 | $2,022.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.82 / $61.67 / $549.82
| Professional | 26 | $37.82 | $61.67 | $549.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.48 / $218.14 / $404.04
| Professional | | $99.48 | $218.14 | $404.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.94 / $66.62 / $119.09
| Professional | 26 | $41.94 | $66.62 | $119.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.66 / $110.22 / $207.81
| Professional | | $50.66 | $110.22 | $207.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.99 / $273.88 / $362.76
| Professional | | $135.99 | $273.88 | $362.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.33 / $96.39 / $126.39
| Professional | 26 | $48.33 | $96.39 | $126.39 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.38 / $193.99 / $193.99
| Facility | 26 | $93.38 | $193.99 | $193.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.79 / $281.67 / $2,022.91
| Professional | | $116.79 | $281.67 | $2,022.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.00 / $65.06 / $549.82
| Professional | 26 | $41.00 | $65.06 | $549.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.99 / $176.16 / $411.63
| Professional | | $108.99 | $176.16 | $411.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.46 / $55.15 / $107.05
| Professional | 26 | $40.46 | $55.15 | $107.05 |