- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $43.65 / $186.21
| Facility | 26 | $42.66 | $43.65 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $112.20 / $223.87
| Professional | | $83.18 | $112.20 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $48.98 / $120.23
| Professional | 26 | $33.11 | $48.98 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $72.44 / $85.11
| Professional | | $72.44 | $72.44 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $44.67 / $66.07
| Professional | 26 | $32.36 | $44.67 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $123.03 / $251.19
| Professional | | $81.28 | $123.03 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $57.54 / $114.82
| Professional | 26 | $35.48 | $57.54 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $40.74 / $40.74
| Facility | 26 | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $120.23 / $229.09
| Professional | | $81.28 | $120.23 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $50.12 / $89.13
| Professional | 26 | $33.11 | $50.12 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Facility | 26 | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $891.25 / $891.25
| Professional | | $794.33 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $309.03 / $389.05 / $389.05
| Professional | 26 | $309.03 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $120.23 / $208.93
| Professional | | $77.62 | $120.23 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $38.90 / $67.61
| Professional | 26 | $32.36 | $38.90 | $67.61 |