- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.56 / $36.56 / $36.56
| Facility | 26 | $36.56 | $36.56 | $36.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.25 / $86.63 / $155.60
| Professional | | $75.25 | $86.63 | $155.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.49 / $39.40 / $95.60
| Professional | 26 | $33.49 | $39.40 | $95.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.45 / $90.41 / $181.07
| Facility | 26 | $81.45 | $90.41 | $181.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.84 / $146.68 / $553.27
| Professional | | $85.84 | $146.68 | $553.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.72 / $65.08 / $234.24
| Professional | 26 | $36.72 | $65.08 | $234.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.40 / $163.51 / $232.40
| Professional | | $99.40 | $163.51 | $232.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.06 / $69.19 / $98.34
| Professional | 26 | $42.06 | $69.19 | $98.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.63 / $133.82 / $283.57
| Professional | | $84.63 | $133.82 | $283.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.83 / $68.97 / $125.18
| Professional | 26 | $39.83 | $68.97 | $125.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.89 / $55.11 / $119.58
| Professional | | $25.89 | $55.11 | $119.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.94 / $188.60 / $248.91
| Professional | | $99.94 | $188.60 | $248.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.65 / $84.70 / $112.38
| Professional | 26 | $44.65 | $84.70 | $112.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.94 / $70.22 / $287.36
| Professional | | $55.94 | $70.22 | $287.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $84.60 / $84.60 / $181.07
| Facility | 26 | $84.60 | $84.60 | $181.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.66 / $158.50 / $553.27
| Professional | | $94.66 | $158.50 | $553.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.56 / $71.94 / $234.24
| Professional | 26 | $40.56 | $71.94 | $234.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.20 / $128.13 / $246.78
| Professional | | $84.20 | $128.13 | $246.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.18 / $54.20 / $105.43
| Professional | 26 | $40.18 | $54.20 | $105.43 |