- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $91.21 / $107.63 / $107.63
| Facility | 26 | $91.21 | $107.63 | $107.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.53 / $27.04 / $39.31
| Professional | | $23.53 | $27.04 | $39.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.34 / $34.60 / $56.23
| Professional | | $33.34 | $34.60 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.04 / $30.04 / $30.04
| Facility | 26 | $30.04 | $30.04 | $30.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.78 / $25.01 / $52.36
| Professional | | $15.78 | $25.01 | $52.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.64 / $46.70 / $61.80
| Professional | | $20.64 | $46.70 | $61.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.97 / $26.97 / $26.97
| Professional | | $26.97 | $26.97 | $26.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.63 / $107.63 / $107.63
| Facility | 26 | $107.63 | $107.63 | $107.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.53 / $27.35 / $241.38
| Professional | | $23.53 | $27.35 | $241.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.82 / $31.90 / $56.97
| Professional | | $7.82 | $31.90 | $56.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.04 / $30.04 / $30.04
| Facility | 26 | $30.04 | $30.04 | $30.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.78 / $31.32 / $53.59
| Professional | | $15.78 | $31.32 | $53.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.17 / $33.99 / $35.36
| Professional | | $33.17 | $33.99 | $35.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.54 / $35.24 / $52.95
| Professional | | $20.54 | $35.24 | $52.95 |