- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.94 / $39.13 / $81.97
| Facility | 26 | $25.94 | $39.13 | $81.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.35 / $49.51 / $189.78
| Professional | | $41.35 | $49.51 | $189.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.17 / $78.18 / $123.64
| Professional | | $47.17 | $78.18 | $123.64 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.10 / $30.10 / $30.10
| Facility | 26 | $30.10 | $30.10 | $30.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.44 / $67.88 / $110.43
| Professional | | $40.44 | $67.88 | $110.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.03 / $65.68 / $140.71
| Professional | | $55.03 | $65.68 | $140.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.61 / $58.98 / $109.78
| Professional | | $53.61 | $58.98 | $109.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.94 / $41.22 / $83.01
| Facility | 26 | $25.94 | $41.22 | $83.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.01 / $56.06 / $153.44
| Professional | | $43.01 | $56.06 | $153.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.26 / $48.04 / $96.00
| Professional | | $23.26 | $48.04 | $96.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.10 / $30.10 / $30.10
| Facility | 26 | $30.10 | $30.10 | $30.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.82 / $66.95 / $106.32
| Professional | | $41.82 | $66.95 | $106.32 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.92 / $25.92 / $30.32
| Facility | 26 | $25.92 | $25.92 | $30.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.02 / $47.73 / $70.56
| Professional | | $47.02 | $47.73 | $70.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.21 / $58.59 / $96.42
| Professional | | $41.21 | $58.59 | $96.42 |