- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $52.48 / $52.48
| Facility | 26 | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $64.57 / $85.11
| Professional | | $56.23 | $64.57 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $44.67 / $58.88
| Professional | 26 | $38.02 | $44.67 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $95.50 / $95.50
| Professional | | $63.10 | $95.50 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.72 / $50.12 / $72.44
| Facility | 26 | $10.72 | $50.12 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $91.20 / $263.03
| Professional | | $64.57 | $91.20 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $61.66 / $181.97
| Professional | 26 | $43.65 | $61.66 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $112.20 / $131.83
| Facility | 26 | $44.67 | $112.20 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $69.18 / $87.10
| Professional | | $58.88 | $69.18 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $47.86 / $61.66
| Professional | 26 | $40.74 | $47.86 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.72 / $50.12 / $72.44
| Facility | 26 | $10.72 | $50.12 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $89.13 / $263.03
| Professional | | $60.26 | $89.13 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $60.26 / $181.97
| Professional | 26 | $40.74 | $60.26 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $72.44 / $102.33
| Professional | | $58.88 | $72.44 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $51.29 / $74.13
| Professional | 26 | $41.69 | $51.29 | $74.13 |