- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.68 / $36.68 / $36.68
| Facility | 26 | $36.68 | $36.68 | $36.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.69 / $59.56 / $107.83
| Professional | | $46.69 | $59.56 | $107.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.97 / $36.68 / $53.74
| Professional | 26 | $28.97 | $36.68 | $53.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.23 / $30.23 / $30.23
| Facility | 26 | $30.23 | $30.23 | $30.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.41 / $150.07 / $200.60
| Professional | | $98.41 | $150.07 | $200.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.15 / $92.15 / $123.18
| Professional | 26 | $61.15 | $92.15 | $123.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $80.36 / $125.42 / $301.70
| Facility | 26 | $80.36 | $125.42 | $301.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.14 / $109.57 / $182.22
| Professional | | $87.14 | $109.57 | $182.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.94 / $67.68 / $111.88
| Professional | 26 | $52.94 | $67.68 | $111.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $69.64 / $110.58 / $237.56
| Facility | 26 | $69.64 | $110.58 | $237.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.28 / $86.28 / $162.35
| Professional | | $86.28 | $86.28 | $162.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.29 / $53.29 / $100.28
| Professional | 26 | $53.29 | $53.29 | $100.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $198.30 / $198.30 / $198.30
| Facility | 26 | $198.30 | $198.30 | $198.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.54 / $154.75 / $696.80
| Professional | | $70.54 | $154.75 | $696.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.94 / $84.13 / $305.45
| Professional | 26 | $41.94 | $84.13 | $305.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.30 / $144.41 / $225.75
| Professional | | $68.30 | $144.41 | $225.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.81 / $73.72 / $120.51
| Professional | 26 | $36.81 | $73.72 | $120.51 |