- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.35 / $29.06 / $76.95
| Facility | 26 | $24.35 | $29.06 | $76.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.29 / $56.95 / $103.40
| Professional | | $50.29 | $56.95 | $103.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.57 / $60.78 / $99.49
| Professional | | $58.57 | $60.78 | $99.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.28 / $28.28 / $28.28
| Facility | 26 | $28.28 | $28.28 | $28.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.87 / $73.75 / $114.68
| Professional | | $45.87 | $73.75 | $114.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.58 / $81.30 / $92.97
| Professional | | $67.58 | $81.30 | $92.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.35 / $44.56 / $79.62
| Facility | 26 | $24.35 | $44.56 | $79.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.08 / $64.41 / $148.82
| Professional | | $53.08 | $64.41 | $148.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.45 / $84.70 / $129.19
| Professional | | $44.45 | $84.70 | $129.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.64 / $28.28 / $28.28
| Facility | 26 | $17.64 | $28.28 | $28.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.72 / $72.97 / $114.68
| Professional | | $46.72 | $72.97 | $114.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.59 / $24.59 / $29.00
| Facility | 26 | $24.59 | $24.59 | $29.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.16 / $58.09 / $69.50
| Professional | | $57.16 | $58.09 | $69.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.96 / $66.30 / $109.13
| Professional | | $51.96 | $66.30 | $109.13 |