- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.37 / $37.88 / $146.37
| Facility | 26 | $23.37 | $37.88 | $146.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.56 / $122.31 / $177.95
| Professional | | $111.56 | $122.31 | $177.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.27 / $25.03 / $35.89
| Professional | 26 | $23.27 | $25.03 | $35.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.80 / $173.06 / $290.19
| Professional | | $97.80 | $173.06 | $290.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.98 / $41.62 / $66.22
| Professional | 26 | $24.98 | $41.62 | $66.22 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.45 / $33.45 / $34.86
| Facility | 26 | $33.45 | $33.45 | $34.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.81 / $157.69 / $264.08
| Professional | | $98.81 | $157.69 | $264.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.22 / $38.93 / $65.09
| Professional | 26 | $25.22 | $38.93 | $65.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $187.81 / $187.81 / $187.81
| Professional | 50 | $187.81 | $187.81 | $187.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $80.98 / $148.53 / $148.53
| Facility | 26 | $80.98 | $148.53 | $148.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.76 / $963.76 / $963.76
| Professional | | $963.76 | $963.76 | $963.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $236.11 / $236.11 / $250.13
| Professional | 26 | $236.11 | $236.11 | $250.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.40 / $150.55 / $249.44
| Professional | | $122.40 | $150.55 | $249.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.24 / $33.42 / $59.18
| Professional | 26 | $27.24 | $33.42 | $59.18 |