- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.94 / $34.94 / $34.94
| Facility | 26 | $34.94 | $34.94 | $34.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.09 / $78.56 / $102.14
| Professional | | $62.09 | $78.56 | $102.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.16 / $35.29 / $45.42
| Professional | 26 | $30.16 | $35.29 | $45.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.38 / $147.38 / $147.38
| Professional | | $147.38 | $147.38 | $147.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.79 / $126.43 / $176.81
| Professional | | $77.79 | $126.43 | $176.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.60 / $56.32 / $78.62
| Professional | 26 | $34.60 | $56.32 | $78.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.97 / $171.68 / $206.57
| Professional | | $153.97 | $171.68 | $206.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.44 / $75.37 / $94.77
| Professional | 26 | $69.44 | $75.37 | $94.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $165.02 / $165.02 / $165.02
| Facility | 26 | $165.02 | $165.02 | $165.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.61 / $159.18 / $553.27
| Professional | | $128.61 | $159.18 | $553.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.33 / $78.98 / $234.24
| Professional | 26 | $59.33 | $78.98 | $234.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.13 / $162.63 / $206.57
| Professional | | $119.13 | $162.63 | $206.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.48 / $81.68 / $168.54
| Professional | | $41.48 | $81.68 | $168.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.71 / $174.47 / $197.21
| Professional | | $128.71 | $174.47 | $197.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.18 / $79.73 / $91.68
| Professional | 26 | $61.18 | $79.73 | $91.68 |