- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.30 / $20.46 / $60.76
| Facility | 26 | $18.30 | $20.46 | $60.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.31 / $81.70 / $127.74
| Professional | | $58.31 | $81.70 | $127.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.09 / $80.12 / $80.12
| Professional | | $49.09 | $80.12 | $80.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.16 / $22.16 / $22.16
| Facility | 26 | $22.16 | $22.16 | $22.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.97 / $84.93 / $165.32
| Professional | | $40.97 | $84.93 | $165.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.01 / $121.22 / $160.72
| Professional | | $83.01 | $121.22 | $160.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.94 / $88.94 / $88.94
| Professional | | $88.94 | $88.94 | $88.94 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.46 / $20.46 / $60.76
| Facility | 26 | $20.46 | $20.46 | $60.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.97 / $87.06 / $202.65
| Professional | | $64.97 | $87.06 | $202.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.69 / $71.09 / $144.01
| Professional | | $20.69 | $71.09 | $144.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.69 / $22.16 / $22.16
| Facility | 26 | $20.69 | $22.16 | $22.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.97 / $91.72 / $171.65
| Professional | | $40.97 | $91.72 | $171.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.84 / $18.84 / $32.84
| Facility | 26 | $18.84 | $18.84 | $32.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.20 / $79.54 / $86.45
| Professional | | $78.20 | $79.54 | $86.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.76 / $89.24 / $172.20
| Professional | | $36.76 | $89.24 | $172.20 |