- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.02 / $4.47 / $4.47
| Facility | 26 | $3.02 | $4.47 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $50.12 / $102.33
| Professional | | $38.90 | $50.12 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $67.61 / $151.36
| Professional | | $47.86 | $67.61 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.02 / $10.23 / $16.98
| Facility | 26 | $3.02 | $10.23 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $109.65 / $154.88
| Professional | | $53.70 | $109.65 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $100.00 / $144.54
| Professional | | $83.18 | $100.00 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $100.00 / $100.00
| Facility | 26 | $8.51 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $100.00 / $446.68
| Professional | | $51.29 | $100.00 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $117.49 / $173.78
| Professional | | $61.66 | $117.49 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $275.42 / $457.09
| Professional | | $53.70 | $275.42 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $5.75 / $5.75 / $5.75
| Facility | 26 | $5.75 | $5.75 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $95.50 / $169.82
| Professional | | $69.18 | $95.50 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $72.44 / $154.88
| Professional | | $48.98 | $72.44 | $154.88 |