- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $25.70 / $60.26
| Facility | 26 | $12.88 | $25.70 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $89.13 / $218.78
| Professional | | $64.57 | $89.13 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $14.13 / $48.98
| Professional | 26 | $12.02 | $14.13 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Professional | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.99 / $35.48 / $44.67
| Professional | 26 | $23.99 | $35.48 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.72 / $17.38 / $24.55
| Facility | 26 | $3.72 | $17.38 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $120.23 / $218.78
| Professional | | $74.13 | $120.23 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $22.39 / $39.81
| Professional | 26 | $12.88 | $22.39 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Professional | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.54 / $27.54 / $27.54
| Professional | 26 | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Professional | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $144.54 / $331.13
| Professional | | $89.13 | $144.54 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $97.72 / $181.97
| Professional | | $69.18 | $97.72 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $18.62 / $33.11
| Professional | 26 | $14.13 | $18.62 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | 26 | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $870.96
| Professional | | $616.60 | $616.60 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Professional | 26 | $162.18 | $162.18 | $162.18 |