- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $43.65 / $51.29
| Facility | 26 | $43.65 | $43.65 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $85.11 / $173.78
| Professional | | $64.57 | $85.11 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $47.86 / $107.15
| Professional | 26 | $38.02 | $47.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $75.86 / $128.82
| Professional | | $57.54 | $75.86 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $51.29 / $75.86
| Professional | 26 | $40.74 | $51.29 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $85.11 / $123.03
| Professional | | $74.13 | $85.11 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $50.12 / $75.86
| Professional | 26 | $42.66 | $50.12 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $97.72 / $154.88
| Professional | | $70.79 | $97.72 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $60.26 / $95.50
| Professional | 26 | $42.66 | $60.26 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $186.21 / $186.21
| Facility | 26 | $95.50 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $104.71 / $489.78
| Professional | | $70.79 | $104.71 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $69.18 / $263.03
| Professional | 26 | $42.66 | $69.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $91.20 / $154.88
| Professional | | $66.07 | $91.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $60.26 / $97.72
| Professional | 26 | $39.81 | $60.26 | $97.72 |