- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.30 / $53.70 / $100.00
| Facility | 26 | $26.30 | $53.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $114.82 / $346.74
| Professional | | $60.26 | $114.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $57.54 / $107.15
| Professional | | $44.67 | $57.54 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $69.18 / $181.97
| Professional | | $67.61 | $69.18 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.76 / $31.62 / $44.67
| Facility | 26 | $6.76 | $31.62 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $91.20 / $151.36
| Professional | | $57.54 | $91.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $97.72 / $117.49
| Professional | | $83.18 | $97.72 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $91.20 / $144.54
| Professional | | $69.18 | $91.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $102.33 / $120.23
| Professional | | $75.86 | $102.33 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.30 / $52.48 / $93.33
| Facility | 26 | $26.30 | $52.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $102.33 / $223.87
| Professional | | $60.26 | $102.33 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $125.89 / $151.36
| Professional | | $50.12 | $125.89 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $26.92 / $30.90
| Facility | 26 | $26.92 | $26.92 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $69.18 / $123.03
| Professional | | $9.77 | $69.18 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $81.28 / $128.82
| Professional | | $57.54 | $81.28 | $128.82 |