- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.88 / $9.52 / $14.50
| Facility | 26 | $7.88 | $9.52 | $14.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.01 / $30.39 / $59.64
| Professional | | $28.01 | $30.39 | $59.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.51 / $7.88 / $19.50
| Professional | 26 | $7.51 | $7.88 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.53 / $30.53 / $30.53
| Professional | | $30.53 | $30.53 | $30.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.60 / $22.60 / $22.60
| Professional | | $22.60 | $22.60 | $22.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.84 / $19.75 / $25.60
| Professional | 26 | $13.84 | $19.75 | $25.60 |
- 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
- $28.27 / $48.11 / $82.47
| Professional | | $28.27 | $48.11 | $82.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.31 / $13.96 / $24.35
| Professional | 26 | $8.31 | $13.96 | $24.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.00 / $12.81 / $25.77
| Facility | 26 | $12.00 | $12.81 | $25.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.00 / $26.00 / $40.70
| Professional | | $12.00 | $26.00 | $40.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.00 / $12.81 / $12.81
| Professional | 26 | $12.00 | $12.81 | $12.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.03 / $40.29 / $70.30
| Professional | | $13.03 | $40.29 | $70.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.93 / $40.09 / $80.44
| Professional | | $27.93 | $40.09 | $80.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.90 / $12.77 / $24.63
| Professional | 26 | $8.90 | $12.77 | $24.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.54 / $100.00 / $100.00
| Facility | 26 | $24.54 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.00 / $233.00 / $289.35
| Professional | | $233.00 | $233.00 | $289.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.41 / $97.41 / $97.41
| Professional | 26 | $97.41 | $97.41 | $97.41 |