- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.73 / $35.35 / $85.54
| Facility | 26 | $26.73 | $35.35 | $85.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.00 / $121.11 / $237.67
| Professional | | $92.00 | $121.11 | $237.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.26 / $131.02 / $213.23
| Professional | | $126.26 | $131.02 | $213.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.72 / $30.72 / $30.72
| Facility | 26 | $30.72 | $30.72 | $30.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.90 / $134.72 / $236.92
| Professional | | $91.90 | $134.72 | $236.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.90 / $169.94 / $204.91
| Professional | | $112.90 | $169.94 | $204.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.73 / $48.92 / $87.41
| Facility | 26 | $26.73 | $48.92 | $87.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.72 / $135.38 / $274.72
| Professional | | $110.72 | $135.38 | $274.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.83 / $119.53 / $267.10
| Professional | | $33.83 | $119.53 | $267.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.96 / $30.72 / $30.72
| Facility | 26 | $17.96 | $30.72 | $30.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.35 / $134.72 / $228.09
| Professional | | $92.35 | $134.72 | $228.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.80 / $26.80 / $29.50
| Facility | 26 | $26.80 | $26.80 | $29.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.00 / $130.18 / $141.69
| Professional | | $90.00 | $130.18 | $141.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.40 / $130.07 / $217.97
| Professional | | $89.40 | $130.07 | $217.97 |