- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $81.28 / $107.15
| Facility | 26 | $30.20 | $81.28 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $60.26 / $165.96
| Professional | | $44.67 | $60.26 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $36.31 / $131.83
| Professional | 26 | $28.18 | $36.31 | $131.83 |
- 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
- $63.10 / $87.10 / $169.82
| Professional | | $63.10 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $50.12 / $93.33
| Professional | 26 | $35.48 | $50.12 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $95.50 / $128.82 / $251.19
| Professional | 50 | $95.50 | $128.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $64.57 / $123.03
| Professional | | $60.26 | $64.57 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $40.74 / $64.57
| Professional | 26 | $37.15 | $40.74 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $100.00 / $181.97
| Professional | | $50.12 | $100.00 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.90 / $53.70 / $104.71
| Professional | 26 | $30.90 | $53.70 | $104.71 |
- 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
- $60.26 / $102.33 / $691.83
| Professional | | $60.26 | $102.33 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $53.70 / $302.00
| Professional | 26 | $34.67 | $53.70 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $77.62 / $134.90
| Professional | | $57.54 | $77.62 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.88 / $44.67 / $69.18
| Professional | 26 | $33.88 | $44.67 | $69.18 |