- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.02 / $18.02 / $67.55
| Facility | 26 | $18.02 | $18.02 | $67.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.87 / $112.37 / $139.79
| Professional | | $86.87 | $112.37 | $139.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.02 / $21.07 / $27.97
| Professional | 26 | $18.02 | $21.07 | $27.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.18 / $57.48 / $111.77
| Facility | 26 | $54.18 | $57.48 | $111.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.28 / $187.53 / $893.01
| Professional | | $108.28 | $187.53 | $893.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.97 / $34.86 / $188.00
| Professional | 26 | $21.97 | $34.86 | $188.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.13 / $43.41 / $57.69
| Professional | 26 | $30.13 | $43.41 | $57.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.77 / $209.56 / $447.72
| Professional | | $108.77 | $209.56 | $447.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.15 / $38.94 / $68.95
| Professional | 26 | $24.15 | $38.94 | $68.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.21 / $155.15 / $259.83
| Professional | | $29.21 | $155.15 | $259.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.61 / $327.50 / $432.22
| Professional | | $162.61 | $327.50 | $432.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.85 / $55.54 / $72.83
| Professional | 26 | $27.85 | $55.54 | $72.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.14 / $33.14 / $36.83
| Professional | | $33.14 | $33.14 | $36.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.18 / $111.77 / $111.77
| Facility | 26 | $54.18 | $111.77 | $111.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.56 / $190.01 / $893.01
| Professional | | $108.56 | $190.01 | $893.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.80 / $37.61 / $188.00
| Professional | 26 | $23.80 | $37.61 | $188.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.42 / $174.60 / $322.37
| Professional | | $105.42 | $174.60 | $322.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.50 / $32.20 / $70.31
| Professional | 26 | $23.50 | $32.20 | $70.31 |