- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.35 / $10.35 / $10.35
| Facility | 26 | $10.35 | $10.35 | $10.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.01 / $39.31 / $54.95
| Professional | | $28.01 | $39.31 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.84 / $9.27 / $11.90
| Professional | 26 | $7.84 | $9.27 | $11.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.42 / $33.42 / $33.42
| Professional | | $33.42 | $33.42 | $33.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.95 / $46.01 / $58.98
| Professional | | $12.95 | $46.01 | $58.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.85 / $13.85 / $13.85
| Professional | 26 | $13.85 | $13.85 | $13.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.01 / $10.01 / $10.01
| Facility | 26 | $10.01 | $10.01 | $10.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.74 / $40.13 / $73.36
| Professional | | $26.74 | $40.13 | $73.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.07 / $11.01 / $21.44
| Professional | 26 | $7.07 | $11.01 | $21.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $7.08 / $10.35
| Facility | 26 | $7.08 | $7.08 | $10.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.02 / $37.06 / $59.31
| Professional | | $25.02 | $37.06 | $59.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $9.33 / $14.67
| Professional | 26 | $7.08 | $9.33 | $14.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.17 / $32.80 / $45.08
| Professional | | $26.17 | $32.80 | $45.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.34 / $32.70 / $47.78
| Professional | | $27.34 | $32.70 | $47.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.21 / $9.77 / $14.40
| Professional | 26 | $8.21 | $9.77 | $14.40 |