- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $34.67 / $64.57
| Facility | 26 | $34.67 | $34.67 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $95.50 / $141.25
| Professional | | $79.43 | $95.50 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.84 / $33.11 / $52.48
| Professional | 26 | $28.84 | $33.11 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $83.18 / $83.18
| Professional | | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $26.92 / $26.92
| Professional | 26 | $26.92 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $117.49 / $186.21
| Professional | | $56.23 | $117.49 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.88 / $47.86 / $72.44
| Professional | 26 | $33.88 | $47.86 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $35.48 / $51.29
| Facility | 26 | $7.59 | $35.48 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $114.82 / $190.55
| Professional | | $87.10 | $114.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $42.66 / $67.61
| Professional | 26 | $32.36 | $42.66 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Facility | 26 | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $741.31 / $741.31
| Professional | | $562.34 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $199.53 / $245.47 / $245.47
| Professional | 26 | $199.53 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $102.33 / $165.96
| Professional | | $75.86 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $38.02 / $63.10
| Professional | 26 | $28.18 | $38.02 | $63.10 |