- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.56 / $32.56 / $32.56
| Facility | 26 | $32.56 | $32.56 | $32.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.02 / $126.05 / $259.63
| Professional | | $46.02 | $126.05 | $259.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.07 / $32.56 / $47.76
| Professional | 26 | $26.07 | $32.56 | $47.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.06 / $27.06 / $27.06
| Facility | 26 | $27.06 | $27.06 | $27.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.30 / $430.94 / $633.47
| Professional | | $259.30 | $430.94 | $633.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.39 / $75.15 / $110.27
| Professional | 26 | $46.39 | $75.15 | $110.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.17 / $112.28 / $270.10
| Facility | 26 | $79.17 | $112.28 | $270.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.90 / $242.00 / $257.64
| Professional | | $204.90 | $242.00 | $257.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.97 / $41.36 / $45.24
| Professional | 26 | $35.97 | $41.36 | $45.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $62.34 / $102.65 / $212.68
| Facility | 26 | $62.34 | $102.65 | $212.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.88 / $202.88 / $231.28
| Professional | | $202.88 | $202.88 | $231.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.63 / $35.63 / $41.33
| Professional | 26 | $35.63 | $35.63 | $41.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.37 / $213.12 / $428.66
| Professional | | $77.37 | $213.12 | $428.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.22 / $59.11 / $116.20
| Professional | 26 | $38.22 | $59.11 | $116.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.09 / $215.70 / $397.72
| Professional | | $74.09 | $215.70 | $397.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.54 / $58.59 / $106.63
| Professional | 26 | $37.54 | $58.59 | $106.63 |