- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.89 / $8.89 / $8.89
| Facility | 26 | $8.89 | $8.89 | $8.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.01 / $33.54 / $61.44
| Professional | | $28.01 | $33.54 | $61.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.40 / $8.82 / $13.32
| Professional | 26 | $7.40 | $8.82 | $13.32 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.20 / $7.20 / $7.20
| Facility | 26 | $7.20 | $7.20 | $7.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.98 / $100.59 / $122.00
| Professional | | $59.98 | $100.59 | $122.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.14 / $25.15 / $30.50
| Professional | 26 | $15.14 | $25.15 | $30.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.23 / $29.21 / $71.83
| Facility | 26 | $17.23 | $29.21 | $71.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.61 / $66.39 / $109.89
| Professional | | $33.61 | $66.39 | $109.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.88 / $16.11 / $26.97
| Professional | 26 | $9.88 | $16.11 | $26.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.36 / $26.33 / $56.56
| Facility | 26 | $15.36 | $26.33 | $56.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.27 / $61.87 / $105.52
| Professional | | $52.27 | $61.87 | $105.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.69 / $15.02 / $25.61
| Professional | 26 | $12.69 | $15.02 | $25.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.85 / $57.35 / $233.00
| Professional | | $33.85 | $57.35 | $233.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.38 / $16.73 / $97.41
| Professional | 26 | $9.38 | $16.73 | $97.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.86 / $108.44
| Professional | | $32.36 | $60.86 | $108.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.38 / $16.16 / $28.60
| Professional | 26 | $9.38 | $16.16 | $28.60 |