- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.57 / $16.32 / $33.86
| Facility | 26 | $11.57 | $16.32 | $33.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.70 / $161.00 / $570.00
| Professional | | $46.70 | $161.00 | $570.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.36 / $43.40 / $166.95
| Professional | 26 | $12.36 | $43.40 | $166.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.53 / $48.35 / $80.00
| Facility | 26 | $27.53 | $48.35 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.39 / $95.31 / $371.18
| Professional | | $54.39 | $95.31 | $371.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.77 / $17.07 / $74.64
| Professional | 26 | $10.77 | $17.07 | $74.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.91 / $22.49 / $29.72
| Professional | 26 | $14.91 | $22.49 | $29.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.54 / $103.57 / $177.37
| Professional | | $46.54 | $103.57 | $177.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.05 / $17.60 / $35.65
| Professional | 26 | $12.05 | $17.60 | $35.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.04 / $50.84 / $89.56
| Professional | | $15.04 | $50.84 | $89.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.71 / $109.97 / $145.69
| Professional | | $55.71 | $109.97 | $145.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.34 / $28.60 / $37.50
| Professional | 26 | $14.34 | $28.60 | $37.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.77 / $19.77 / $21.10
| Professional | | $19.77 | $19.77 | $21.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.85 / $80.00 / $80.00
| Facility | 26 | $27.85 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.09 / $100.10 / $371.18
| Professional | | $54.09 | $100.10 | $371.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.83 / $17.07 / $74.64
| Professional | 26 | $11.83 | $17.07 | $74.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.41 / $88.94 / $149.33
| Professional | | $53.41 | $88.94 | $149.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.70 / $16.32 / $33.22
| Professional | 26 | $11.70 | $16.32 | $33.22 |