- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.09 / $43.98 / $68.34
| Facility | 26 | $36.09 | $43.98 | $68.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.91 / $98.77 / $194.96
| Professional | | $91.91 | $98.77 | $194.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.18 / $36.09 / $68.34
| Professional | 26 | $33.18 | $36.09 | $68.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.82 / $103.82 / $103.82
| Professional | | $103.82 | $103.82 | $103.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.34 / $95.59 / $118.35
| Professional | 26 | $63.34 | $95.59 | $118.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.12 / $45.12 / $45.12
| Facility | 26 | $45.12 | $45.12 | $45.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.95 / $234.86 / $490.15
| Professional | | $109.95 | $234.86 | $490.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.94 / $63.94 / $113.55
| Professional | 26 | $38.94 | $63.94 | $113.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.71 / $69.00 / $122.73
| Facility | 26 | $58.71 | $69.00 | $122.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.00 / $68.00 / $186.74
| Professional | | $55.00 | $68.00 | $186.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.71 / $58.71 / $147.57
| Professional | 26 | $58.71 | $58.71 | $147.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.96 / $104.02 / $198.21
| Professional | | $41.96 | $104.02 | $198.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.08 / $184.73 / $324.37
| Professional | | $103.08 | $184.73 | $324.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.19 / $56.95 / $106.80
| Professional | 26 | $41.19 | $56.95 | $106.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $193.99 / $193.99
| Facility | 26 | $100.00 | $193.99 | $193.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,022.91 / $2,022.91 / $2,022.91
| Professional | | $2,022.91 | $2,022.91 | $2,022.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $549.82 / $549.82 / $549.82
| Professional | 26 | $549.82 | $549.82 | $549.82 |