- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $15.85 / $53.70
| Facility | 26 | $7.94 | $15.85 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $91.20 / $436.52
| Professional | | $67.61 | $91.20 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $141.25 / $281.84
| Professional | | $97.72 | $141.25 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $131.83 / $302.00
| Professional | | $93.33 | $131.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $109.65 / $245.47
| Professional | | $75.86 | $109.65 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $147.91
| Professional | | $109.65 | $109.65 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $10.00 / $13.49
| Professional | 26 | $10.00 | $10.00 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $107.15 / $199.53
| Professional | | $83.18 | $107.15 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $11.48 / $20.89
| Professional | 26 | $8.51 | $11.48 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $70.79 / $85.11
| Facility | 26 | $70.79 | $70.79 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $691.83 / $691.83
| Professional | | $512.86 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $66.07 / $75.86
| Professional | | $10.47 | $66.07 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $109.65 / $239.88
| Professional | | $75.86 | $109.65 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Professional | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $93.33 / $234.42
| Professional | | $69.18 | $93.33 | $234.42 |