- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $44.67 / $44.67
| Facility | 26 | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $81.28 / $190.55
| Professional | | $64.57 | $81.28 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $44.67 / $123.03
| Professional | 26 | $38.02 | $44.67 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $35.48 / $37.15
| Facility | 26 | $35.48 | $35.48 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $169.82 / $269.15
| Professional | | $107.15 | $169.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $91.20 / $144.54
| Professional | 26 | $58.88 | $91.20 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $151.36 / $363.08
| Facility | 26 | $107.15 | $151.36 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $213.80 / $323.59
| Professional | | $128.82 | $213.80 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $114.82 / $173.78
| Professional | 26 | $69.18 | $114.82 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $117.49 / $144.54 / $281.84
| Facility | 26 | $117.49 | $144.54 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $190.55 / $309.03
| Professional | | $131.83 | $190.55 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $102.33 / $165.96
| Professional | 26 | $70.79 | $102.33 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Facility | 26 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $131.83 / $257.04
| Professional | | $74.13 | $131.83 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $83.18 / $154.88
| Professional | 26 | $45.71 | $83.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $141.25 / $251.19
| Professional | | $77.62 | $141.25 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.86 / $83.18 / $144.54
| Professional | 26 | $47.86 | $83.18 | $144.54 |