- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.22 / $39.22 / $39.22
| Facility | 26 | $39.22 | $39.22 | $39.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.53 / $75.28 / $273.00
| Professional | | $59.53 | $75.28 | $273.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.32 / $39.22 / $54.46
| Professional | 26 | $33.32 | $39.22 | $54.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.63 / $124.41 / $236.68
| Professional | | $81.63 | $124.41 | $236.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.75 / $64.09 / $99.48
| Professional | 26 | $47.75 | $64.09 | $99.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.55 / $124.22 / $298.83
| Facility | 26 | $87.55 | $124.22 | $298.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.56 / $193.10 / $300.70
| Professional | | $119.56 | $193.10 | $300.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.07 / $97.01 / $151.07
| Professional | 26 | $60.07 | $97.01 | $151.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.20 / $113.36 / $235.30
| Facility | 26 | $71.20 | $113.36 | $235.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.19 / $176.38 / $271.70
| Professional | | $106.19 | $176.38 | $271.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.35 / $88.61 / $136.50
| Professional | 26 | $53.35 | $88.61 | $136.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $158.93 / $158.93 / $158.93
| Facility | 26 | $158.93 | $158.93 | $158.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.58 / $130.12 / $244.89
| Professional | | $73.58 | $130.12 | $244.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.08 / $73.75 / $138.04
| Professional | 26 | $42.08 | $73.75 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.26 / $132.28 / $235.66
| Professional | | $76.26 | $132.28 | $235.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.45 / $78.50 / $131.19
| Professional | 26 | $42.45 | $78.50 | $131.19 |