- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.07 / $24.32 / $58.55
| Facility | 26 | $22.07 | $24.32 | $58.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.27 / $137.59 / $181.62
| Professional | | $117.27 | $137.59 | $181.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.72 / $23.75 / $32.20
| Professional | 26 | $21.72 | $23.75 | $32.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.22 / $156.22 / $156.22
| Professional | | $156.22 | $156.22 | $156.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.08 / $21.08 / $21.08
| Professional | 26 | $21.08 | $21.08 | $21.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.24 / $184.46 / $285.39
| Professional | | $125.24 | $184.46 | $285.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.87 / $30.32 / $46.71
| Professional | 26 | $20.87 | $30.32 | $46.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.72 / $26.72 / $26.72
| Facility | 26 | $26.72 | $26.72 | $26.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.44 / $180.12 / $313.66
| Professional | | $137.44 | $180.12 | $313.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.56 / $30.29 / $52.43
| Professional | 26 | $22.56 | $30.29 | $52.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.98 / $108.44 / $108.44
| Facility | 26 | $52.98 | $108.44 | $108.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.52 / $845.52 / $1,121.48
| Professional | | $845.52 | $845.52 | $1,121.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $147.91 / $147.91 / $187.20
| Professional | 26 | $147.91 | $147.91 | $187.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.05 / $173.28 / $304.77
| Professional | | $134.05 | $173.28 | $304.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.70 / $28.98 / $51.15
| Professional | 26 | $22.70 | $28.98 | $51.15 |