- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.00 / $100.96 / $135.24
| Facility | 26 | $40.00 | $100.96 | $135.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.93 / $72.27 / $177.68
| Professional | | $64.93 | $72.27 | $177.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.00 / $42.89 / $205.00
| Professional | 26 | $40.00 | $42.89 | $205.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.80 / $162.80 / $162.80
| Professional | | $162.80 | $162.80 | $162.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.56 / $114.53 / $155.84
| Professional | | $68.56 | $114.53 | $155.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.60 / $62.81 / $85.45
| Professional | 26 | $37.60 | $62.81 | $85.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.57 / $153.41 / $178.51
| Professional | | $86.57 | $153.41 | $178.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.94 / $86.62 / $105.78
| Professional | 26 | $53.94 | $86.62 | $105.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.12 / $184.67 / $184.67
| Facility | 26 | $96.12 | $184.67 | $184.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.44 / $137.60 / $493.66
| Professional | | $89.44 | $137.60 | $493.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.20 / $84.92 / $264.24
| Professional | 26 | $55.20 | $84.92 | $264.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.32 / $142.90 / $184.92
| Professional | | $97.32 | $142.90 | $184.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.29 / $77.25 / $154.16
| Professional | | $37.29 | $77.25 | $154.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.44 / $137.68 / $181.40
| Professional | | $89.44 | $137.68 | $181.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.20 / $92.71 / $105.18
| Professional | 26 | $55.20 | $92.71 | $105.18 |