- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $41.87 / $41.87 / $41.87
| Facility | 26 | $41.87 | $41.87 | $41.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.25 / $108.05 / $162.71
| Professional | | $81.25 | $108.05 | $162.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.69 / $41.87 / $65.17
| Professional | 26 | $32.69 | $41.87 | $65.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.40 / $35.40 / $35.40
| Facility | 26 | $35.40 | $35.40 | $35.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.08 / $317.25 / $384.78
| Professional | | $195.08 | $317.25 | $384.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.79 / $118.97 / $144.29
| Professional | 26 | $72.79 | $118.97 | $144.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $92.60 / $144.53 / $347.68
| Facility | 26 | $92.60 | $144.53 | $347.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.92 / $217.85 / $360.60
| Professional | | $115.92 | $217.85 | $360.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.28 / $79.92 / $133.78
| Professional | 26 | $45.28 | $79.92 | $133.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $80.25 / $131.88 / $273.76
| Facility | 26 | $80.25 | $131.88 | $273.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.54 / $203.04 / $346.28
| Professional | | $171.54 | $203.04 | $346.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.93 / $74.48 / $127.04
| Professional | 26 | $62.93 | $74.48 | $127.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $189.21 / $189.21 / $189.21
| Facility | 26 | $189.21 | $189.21 | $189.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.44 / $180.14 / $683.45
| Professional | | $106.44 | $180.14 | $683.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.67 / $77.59 / $282.35
| Professional | 26 | $43.67 | $77.59 | $282.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.88 / $166.24 / $348.03
| Professional | | $103.88 | $166.24 | $348.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.88 / $71.51 / $133.13
| Professional | 26 | $42.88 | $71.51 | $133.13 |