- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $120.23 / $151.36 / $165.96
| Facility | 26 | $120.23 | $151.36 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $85.11 / $354.81
| Professional | | $45.71 | $85.11 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $39.81 / $120.23
| Professional | 26 | $28.18 | $39.81 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Professional | 50 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $52.48 / $91.20
| Professional | | $46.77 | $52.48 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $31.62 / $54.95
| Professional | 26 | $28.18 | $31.62 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $39.81 / $56.23
| Facility | 26 | $8.51 | $39.81 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $97.72 / $158.49
| Professional | | $50.12 | $97.72 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $51.29 / $83.18
| Professional | 26 | $30.20 | $51.29 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $199.53 / $199.53
| Facility | 26 | $81.28 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $102.33 / $691.83
| Professional | | $63.10 | $102.33 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $51.29 / $302.00
| Professional | 26 | $35.48 | $51.29 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $95.50 / $131.83
| Professional | | $57.54 | $95.50 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $50.12 / $69.18
| Professional | 26 | $34.67 | $50.12 | $69.18 |