- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $103.14 / $125.00 / $193.45
| Facility | 26 | $103.14 | $125.00 | $193.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.63 / $125.00 / $265.00
| Professional | 26 | $93.63 | $125.00 | $265.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.59 / $92.28 / $198.71
| Professional | 26 | $70.59 | $92.28 | $198.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.81 / $95.81 / $95.81
| Facility | 26 | $95.81 | $95.81 | $95.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.41 / $117.25 / $259.25
| Professional | 26 | $62.41 | $117.25 | $259.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.03 / $102.17 / $172.57
| Professional | 26 | $73.03 | $102.17 | $172.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.03 / $94.62 / $148.22
| Professional | 26 | $73.03 | $94.62 | $148.22 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.81 / $95.81 / $95.81
| Facility | 26 | $95.81 | $95.81 | $95.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.27 / $119.64 / $282.22
| Professional | 26 | $65.27 | $119.64 | $282.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.77 / $94.14 / $194.43
| Professional | 26 | $69.77 | $94.14 | $194.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $89.87 / $89.87 / $313.66
| Facility | 26 | $89.87 | $89.87 | $313.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.44 / $94.91 / $243.18
| Professional | 26 | $78.44 | $94.91 | $243.18 |