- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.04 / $39.04 / $39.04
| Facility | 26 | $39.04 | $39.04 | $39.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.60 / $118.74 / $189.87
| Professional | | $96.60 | $118.74 | $189.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.17 / $37.06 / $81.55
| Professional | 26 | $20.17 | $37.06 | $81.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.96 / $31.96 / $31.96
| Facility | 26 | $31.96 | $31.96 | $31.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.64 / $353.03 / $428.18
| Professional | | $209.64 | $353.03 | $428.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.39 / $109.30 / $132.56
| Professional | 26 | $66.39 | $109.30 | $132.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $76.56 / $129.69 / $318.94
| Facility | 26 | $76.56 | $129.69 | $318.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.95 / $233.96 / $387.27
| Professional | | $107.95 | $233.96 | $387.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.80 / $72.19 / $119.33
| Professional | 26 | $29.80 | $72.19 | $119.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $68.18 / $116.89 / $251.14
| Facility | 26 | $68.18 | $116.89 | $251.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.22 / $218.05 / $371.89
| Professional | | $184.22 | $218.05 | $371.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.84 / $67.28 / $114.74
| Professional | 26 | $56.84 | $67.28 | $114.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $172.60 / $172.60 / $172.60
| Facility | 26 | $172.60 | $172.60 | $172.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.16 / $196.22 / $810.58
| Professional | | $116.16 | $196.22 | $810.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.94 / $53.58 / $242.65
| Professional | 26 | $30.94 | $53.58 | $242.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.16 / $190.08 / $381.08
| Professional | | $116.16 | $190.08 | $381.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.94 / $50.23 / $127.68
| Professional | 26 | $30.94 | $50.23 | $127.68 |