- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $5.90 / $10.50 / $30.33
| Facility | 26 | $5.90 | $10.50 | $30.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.98 / $28.97 / $44.04
| Professional | | $21.98 | $28.97 | $44.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.90 / $7.88 / $11.74
| Professional | 26 | $5.90 | $7.88 | $11.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.41 / $25.83 / $72.02
| Professional | | $22.41 | $25.83 | $72.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.01 / $10.01 / $26.51
| Facility | 26 | $10.01 | $10.01 | $26.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.90 / $32.39 / $62.59
| Professional | | $22.90 | $32.39 | $62.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.17 / $10.08 / $17.98
| Professional | 26 | $6.17 | $10.08 | $17.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.66 / $9.66 / $9.66
| Facility | 26 | $9.66 | $9.66 | $9.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.41 / $32.00 / $43.77
| Professional | | $22.41 | $32.00 | $43.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.27 / $10.11 / $12.68
| Professional | 26 | $6.27 | $10.11 | $12.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.90 / $33.44 / $55.51
| Professional | | $15.90 | $33.44 | $55.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.94 / $27.74 / $57.68
| Professional | | $22.94 | $27.74 | $57.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.94 / $7.91 / $16.60
| Professional | 26 | $6.94 | $7.91 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.34 / $19.34 / $19.34
| Professional | | $19.34 | $19.34 | $19.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.83 / $4.83 / $4.83
| Professional | 26 | $4.83 | $4.83 | $4.83 |