- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.48 / $22.48 / $22.48
| Facility | 26 | $22.48 | $22.48 | $22.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.01 / $34.96 / $69.78
| Professional | | $28.01 | $34.96 | $69.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.92 / $9.27 / $18.52
| Professional | 26 | $7.92 | $9.27 | $18.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.91 / $53.31 / $62.72
| Professional | | $29.91 | $53.31 | $62.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.71 / $14.57 / $17.14
| Professional | 26 | $9.71 | $14.57 | $17.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.43 / $113.43 / $125.92
| Professional | | $113.43 | $113.43 | $125.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.32 / $42.32 / $51.18
| Professional | 26 | $42.32 | $42.32 | $51.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.98 / $58.31 / $73.97
| Professional | | $54.98 | $58.31 | $73.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.88 / $15.98 / $18.96
| Professional | 26 | $13.88 | $15.98 | $18.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.05 / $32.34 / $59.48
| Professional | | $14.05 | $32.34 | $59.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $156.94 / $156.94 / $156.94
| Facility | 26 | $156.94 | $156.94 | $156.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.55 / $71.23 / $80.84
| Professional | | $60.55 | $71.23 | $80.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.14 / $17.80 / $21.26
| Professional | 26 | $15.14 | $17.80 | $21.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.65 / $35.61 / $63.91
| Professional | | $31.65 | $35.61 | $63.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.85 / $9.88 / $17.98
| Professional | 26 | $8.85 | $9.88 | $17.98 |