- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.52 / $33.06 / $33.06
| Facility | 26 | $29.52 | $33.06 | $33.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.17 / $79.20 / $93.60
| Professional | | $66.17 | $79.20 | $93.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.43 / $77.43 / $77.43
| Professional | | $77.43 | $77.43 | $77.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.76 / $80.70 / $80.70
| Professional | | $77.76 | $80.70 | $80.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.17 / $35.17 / $35.17
| Facility | 26 | $35.17 | $35.17 | $35.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.38 / $95.68 / $173.95
| Professional | | $66.38 | $95.68 | $173.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.35 / $120.45 / $161.36
| Professional | | $82.35 | $120.45 | $161.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.96 / $109.96 / $109.96
| Professional | | $109.96 | $109.96 | $109.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.06 / $33.06 / $33.06
| Facility | 26 | $33.06 | $33.06 | $33.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.65 / $83.27 / $169.90
| Professional | | $71.65 | $83.27 | $169.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.22 / $76.66 / $143.91
| Professional | | $33.22 | $76.66 | $143.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.79 / $35.17 / $35.17
| Facility | 26 | $32.79 | $35.17 | $35.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.47 / $95.68 / $186.36
| Professional | | $66.47 | $95.68 | $186.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.39 / $30.39 / $40.32
| Facility | 26 | $30.39 | $30.39 | $40.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.01 / $79.06 / $85.28
| Professional | | $78.01 | $79.06 | $85.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.29 / $84.17 / $153.28
| Professional | | $59.29 | $84.17 | $153.28 |