- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $186.21 / $194.98
| Facility | 26 | $56.23 | $186.21 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $61.66 / $141.25
| Professional | | $45.71 | $61.66 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $36.31 / $74.13
| Professional | 26 | $28.18 | $36.31 | $74.13 |
- 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
- $43.65 / $91.20 / $165.96
| Professional | | $43.65 | $91.20 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $63.10 / $100.00
| Professional | 26 | $39.81 | $63.10 | $100.00 |
- 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
- $54.95 / $100.00 / $177.83
| Professional | | $54.95 | $100.00 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $54.95 / $93.33
| Professional | 26 | $33.11 | $54.95 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Facility | 26 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Professional | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Professional | 26 | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $95.50 / $151.36
| Professional | | $56.23 | $95.50 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $50.12 / $77.62
| Professional | 26 | $33.11 | $50.12 | $77.62 |