- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $41.69 / $85.11
| Facility | 26 | $41.69 | $41.69 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $85.11 / $204.17
| Professional | | $60.26 | $85.11 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $48.98 / $128.82
| Professional | 26 | $38.02 | $48.98 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $97.72 / $263.03
| Facility | 26 | $32.36 | $97.72 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $107.15 / $489.78
| Professional | | $67.61 | $107.15 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $60.26 / $263.03
| Professional | 26 | $37.15 | $60.26 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $151.36 / $295.12
| Professional | | $91.20 | $151.36 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.77 / $77.62 / $123.03
| Professional | 26 | $46.77 | $77.62 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $114.82 / $269.15
| Professional | | $79.43 | $114.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $67.61 / $141.25
| Professional | 26 | $45.71 | $67.61 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $52.48 / $112.20
| Professional | | $24.55 | $52.48 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $107.15 / $204.17
| Professional | | $77.62 | $107.15 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $61.66 / $109.65
| Professional | 26 | $41.69 | $61.66 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $97.72 / $263.03
| Facility | 26 | $32.36 | $97.72 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $109.65 / $489.78
| Professional | | $67.61 | $109.65 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.90 / $60.26 / $263.03
| Professional | 26 | $38.90 | $60.26 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $112.20 / $223.87
| Professional | | $77.62 | $112.20 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $64.57 / $128.82
| Professional | 26 | $44.67 | $64.57 | $128.82 |