- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.54 / $87.96 / $117.88
| Facility | 26 | $34.54 | $87.96 | $117.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.71 / $66.84 / $138.96
| Professional | | $59.71 | $66.84 | $138.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.54 / $36.86 / $91.03
| Professional | 26 | $34.54 | $36.86 | $91.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.60 / $130.60 / $130.60
| Professional | | $130.60 | $130.60 | $130.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.13 / $105.44 / $143.47
| Professional | | $63.13 | $105.44 | $143.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.46 / $54.21 / $73.76
| Professional | 26 | $32.46 | $54.21 | $73.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.55 / $140.43 / $164.26
| Professional | | $78.55 | $140.43 | $164.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.81 / $74.97 / $91.80
| Professional | 26 | $46.81 | $74.97 | $91.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.11 / $158.93 / $158.93
| Facility | 26 | $83.11 | $158.93 | $158.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.02 / $125.61 / $457.11
| Professional | | $82.02 | $125.61 | $457.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.78 / $73.50 / $229.85
| Professional | 26 | $47.78 | $73.50 | $229.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.07 / $131.55 / $170.13
| Professional | | $89.07 | $131.55 | $170.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.94 / $69.31 / $141.94
| Professional | | $36.94 | $69.31 | $141.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.02 / $127.64 / $167.13
| Professional | | $82.02 | $127.64 | $167.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.78 / $71.66 / $91.03
| Professional | 26 | $47.78 | $71.66 | $91.03 |