- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.00 / $145.00 / $303.33
| Facility | 26 | $125.00 | $145.00 | $303.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $113.31 / $162.63 / $360.33
| Professional | 26 | $113.31 | $162.63 | $360.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $145.41 / $145.41 / $145.41
| Professional | 26 | $145.41 | $145.41 | $145.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.54 / $132.04 / $269.07
| Professional | 26 | $102.54 | $132.04 | $269.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $130.13 / $130.13 / $130.13
| Facility | 26 | $130.13 | $130.13 | $130.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.43 / $154.25 / $350.08
| Professional | 26 | $84.43 | $154.25 | $350.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $99.05 / $140.34 / $236.46
| Professional | 26 | $99.05 | $140.34 | $236.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $99.05 / $122.44 / $200.76
| Professional | 26 | $99.05 | $122.44 | $200.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $126.83 / $143.35 / $234.68
| Professional | 26 | $126.83 | $143.35 | $234.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $130.13 / $130.13 / $130.13
| Facility | 26 | $130.13 | $130.13 | $130.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.60 / $158.33 / $350.08
| Professional | 26 | $84.60 | $158.33 | $350.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $96.19 / $127.69 / $260.13
| Professional | 26 | $96.19 | $127.69 | $260.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $121.73 / $121.73 / $395.52
| Facility | 26 | $121.73 | $121.73 | $395.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.48 / $130.06 / $289.76
| Professional | 26 | $107.48 | $130.06 | $289.76 |