- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.90 / $40.90 / $69.53
| Facility | 26 | $40.90 | $40.90 | $69.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.81 / $87.67 / $115.54
| Professional | | $79.81 | $87.67 | $115.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.75 / $40.95 / $214.16
| Professional | 26 | $38.75 | $40.95 | $214.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.54 / $34.54 / $34.54
| Facility | 26 | $34.54 | $34.54 | $34.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.91 / $218.57 / $315.38
| Professional | | $137.91 | $218.57 | $315.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.36 / $118.83 / $166.82
| Professional | 26 | $77.36 | $118.83 | $166.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.23 / $142.13 / $341.93
| Facility | 26 | $100.23 | $142.13 | $341.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.59 / $282.39 / $404.47
| Professional | | $168.59 | $282.39 | $404.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.58 / $137.04 / $195.71
| Professional | 26 | $81.58 | $137.04 | $195.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.48 / $129.94 / $269.24
| Facility | 26 | $81.48 | $129.94 | $269.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.43 / $254.00 / $336.61
| Professional | | $148.43 | $254.00 | $336.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.81 / $122.91 / $162.88
| Professional | 26 | $71.81 | $122.91 | $162.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.15 / $203.06 / $454.84
| Professional | | $115.15 | $203.06 | $454.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.85 / $110.39 / $247.27
| Professional | 26 | $59.85 | $110.39 | $247.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.93 / $175.24 / $327.90
| Professional | | $106.93 | $175.24 | $327.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.65 / $110.39 / $185.28
| Professional | 26 | $60.65 | $110.39 | $185.28 |