- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.98 / $48.98 / $48.98
| Facility | 26 | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $64.57 / $87.10
| Professional | | $56.23 | $64.57 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $44.67 / $61.66
| Professional | 26 | $38.02 | $44.67 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $38.02 / $38.02
| Facility | 26 | $33.11 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $154.88 / $223.87
| Professional | | $93.33 | $154.88 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $104.71 / $151.36
| Professional | 26 | $64.57 | $104.71 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $158.49 / $398.11
| Facility | 26 | $50.12 | $158.49 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $177.83 / $281.84
| Professional | | $100.00 | $177.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $120.23 / $190.55
| Professional | 26 | $69.18 | $120.23 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $128.82 / $158.49 / $309.03
| Facility | 26 | $128.82 | $158.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $165.96 / $257.04
| Professional | | $117.49 | $165.96 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.43 / $112.20 / $173.78
| Professional | 26 | $79.43 | $112.20 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $120.23 / $407.38
| Professional | | $64.57 | $120.23 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $85.11 / $281.84
| Professional | 26 | $45.71 | $85.11 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $120.23 / $223.87
| Professional | | $66.07 | $120.23 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $85.11 / $158.49
| Professional | 26 | $45.71 | $85.11 | $158.49 |