- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.86 / $39.86 / $39.86
| Facility | 26 | $39.86 | $39.86 | $39.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.90 / $90.52 / $142.09
| Professional | | $75.90 | $90.52 | $142.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.39 / $39.79 / $67.47
| Professional | 26 | $34.39 | $39.79 | $67.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.81 / $30.81 / $30.81
| Facility | 26 | $30.81 | $30.81 | $30.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.15 / $221.11 / $290.93
| Professional | | $119.15 | $221.11 | $290.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.22 / $96.50 / $126.69
| Professional | 26 | $53.22 | $96.50 | $126.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $90.12 / $127.80 / $307.45
| Facility | 26 | $90.12 | $127.80 | $307.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.72 / $227.29 / $353.93
| Professional | | $140.72 | $227.29 | $353.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.78 / $99.78 / $155.38
| Professional | 26 | $61.78 | $99.78 | $155.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.89 / $116.84 / $242.09
| Facility | 26 | $81.89 | $116.84 | $242.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.33 / $211.56 / $319.80
| Professional | | $139.33 | $211.56 | $319.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.17 / $92.88 / $140.40
| Professional | 26 | $61.17 | $92.88 | $140.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.04 / $185.74 / $435.05
| Professional | | $98.04 | $185.74 | $435.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.88 / $80.48 / $234.24
| Professional | 26 | $42.88 | $80.48 | $234.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.02 / $165.13 / $317.10
| Professional | | $94.02 | $165.13 | $317.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.88 / $80.27 / $140.65
| Professional | 26 | $42.88 | $80.27 | $140.65 |