- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.32 / $38.92 / $93.70
| Facility | 26 | $35.32 | $38.92 | $93.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.25 / $87.19 / $142.09
| Professional | | $75.25 | $87.19 | $142.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.77 / $38.68 / $57.17
| Professional | 26 | $33.77 | $38.68 | $57.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $175.56 / $175.56 / $175.56
| Professional | 50 | $175.56 | $175.56 | $175.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.72 / $90.76 / $162.18
| Professional | | $76.72 | $90.76 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.78 / $40.67 / $61.98
| Professional | 26 | $38.78 | $40.67 | $61.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.30 / $102.50 / $156.11
| Professional | | $73.30 | $102.50 | $156.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.47 / $45.75 / $72.25
| Professional | 26 | $32.47 | $45.75 | $72.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.77 / $107.12 / $184.04
| Professional | | $76.77 | $107.12 | $184.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.29 / $48.66 / $86.95
| Professional | 26 | $36.29 | $48.66 | $86.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $84.60 / $165.02 / $181.07
| Facility | 26 | $84.60 | $165.02 | $181.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.27 / $553.27 / $676.35
| Professional | | $553.27 | $553.27 | $676.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $234.24 / $234.24 / $294.52
| Professional | 26 | $234.24 | $234.24 | $294.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.63 / $95.28 / $168.48
| Professional | | $73.63 | $95.28 | $168.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.19 / $45.58 / $86.22
| Professional | 26 | $31.19 | $45.58 | $86.22 |