- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.20 / $38.90 / $93.33
| Facility | 26 | $18.20 | $38.90 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $128.82 / $371.54
| Professional | | $85.11 | $128.82 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.20 / $22.91 / $69.18
| Professional | 26 | $18.20 | $22.91 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.95 / $144.54 / $144.54
| Facility | 26 | $54.95 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $162.18 / $891.25
| Professional | | $104.71 | $162.18 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.42 / $32.36 / $186.21
| Professional | 26 | $20.42 | $32.36 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.70 / $44.67 / $58.88
| Professional | 26 | $25.70 | $44.67 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $186.21 / $380.19
| Professional | | $100.00 | $186.21 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $35.48 / $67.61
| Professional | 26 | $20.89 | $35.48 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $165.96 / $275.42
| Professional | | $30.20 | $165.96 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $218.78 / $416.87
| Professional | | $134.90 | $218.78 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.99 / $35.48 / $64.57
| Professional | 26 | $23.99 | $35.48 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Professional | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.95 / $144.54 / $144.54
| Facility | 26 | $54.95 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $165.96 / $891.25
| Professional | | $104.71 | $165.96 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.42 / $32.36 / $186.21
| Professional | 26 | $20.42 | $32.36 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $169.82 / $371.54
| Professional | | $104.71 | $169.82 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.91 / $32.36 / $63.10
| Professional | 26 | $22.91 | $32.36 | $63.10 |