- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $49.26 / $49.26 / $49.26
| Facility | 26 | $49.26 | $49.26 | $49.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.34 / $72.18 / $89.68
| Professional | | $59.34 | $72.18 | $89.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.90 / $49.26 / $62.64
| Professional | 26 | $40.90 | $49.26 | $62.64 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.29 / $38.29 / $38.29
| Facility | 26 | $38.29 | $38.29 | $38.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.74 / $171.90 / $226.41
| Professional | | $94.74 | $171.90 | $226.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.94 / $117.69 / $154.85
| Professional | 26 | $64.94 | $117.69 | $154.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $111.18 / $157.66 / $379.29
| Facility | 26 | $111.18 | $157.66 | $379.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.55 / $180.17 / $280.55
| Professional | | $111.55 | $180.17 | $280.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.08 / $122.88 / $191.35
| Professional | 26 | $76.08 | $122.88 | $191.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $101.02 / $144.13 / $298.64
| Facility | 26 | $101.02 | $144.13 | $298.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.45 / $167.70 / $253.50
| Professional | | $110.45 | $167.70 | $253.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.33 / $114.38 / $172.90
| Professional | 26 | $75.33 | $114.38 | $172.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.45 / $129.30 / $324.63
| Professional | | $71.45 | $129.30 | $324.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.81 / $91.22 / $278.89
| Professional | 26 | $50.81 | $91.22 | $278.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.45 / $127.90 / $236.62
| Professional | | $71.45 | $127.90 | $236.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.28 / $91.22 / $167.99
| Professional | 26 | $50.28 | $91.22 | $167.99 |