- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.59 / $20.59 / $34.72
| Facility | 26 | $20.59 | $20.59 | $34.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.82 / $50.41 / $66.92
| Professional | | $33.82 | $50.41 | $66.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.16 / $20.67 / $31.67
| Professional | 26 | $19.16 | $20.67 | $31.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Professional | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.13 / $26.92 / $68.76
| Professional | 26 | $19.13 | $26.92 | $68.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.51 / $23.51 / $23.51
| Facility | 26 | $23.51 | $23.51 | $23.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.49 / $61.11 / $107.41
| Professional | | $41.49 | $61.11 | $107.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.58 / $35.04 / $56.50
| Professional | 26 | $23.58 | $35.04 | $56.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.37 / $28.09 / $45.91
| Facility | 26 | $24.37 | $28.09 | $45.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.00 / $31.18 / $45.00
| Professional | | $16.00 | $31.18 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.46 / $46.45 / $80.29
| Professional | | $31.46 | $46.45 | $80.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.54 / $44.92 / $78.30
| Professional | | $31.54 | $44.92 | $78.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.29 / $25.22 / $52.49
| Professional | 26 | $19.29 | $25.22 | $52.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.04 / $80.00 / $100.32
| Facility | 26 | $48.04 | $80.00 | $100.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.15 / $331.15 / $420.15
| Professional | | $331.15 | $331.15 | $420.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $130.11 / $130.11 / $164.40
| Professional | 26 | $130.11 | $130.11 | $164.40 |