- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.60 / $33.17 / $71.22
| Facility | 26 | $21.60 | $33.17 | $71.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.56 / $52.27 / $195.48
| Professional | | $41.56 | $52.27 | $195.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.91 / $49.91 / $49.91
| Professional | | $49.91 | $49.91 | $49.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.82 / $53.67 / $124.55
| Professional | | $42.82 | $53.67 | $124.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.27 / $38.78 / $73.05
| Professional | | $34.27 | $38.78 | $73.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.10 / $30.10 / $30.10
| Facility | 26 | $30.10 | $30.10 | $30.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.31 / $78.31 / $159.44
| Professional | | $41.31 | $78.31 | $159.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.52 / $65.23 / $98.98
| Professional | | $48.52 | $65.23 | $98.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.61 / $57.74 / $103.48
| Professional | | $36.61 | $57.74 | $103.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.10 / $30.10 / $30.10
| Facility | 26 | $30.10 | $30.10 | $30.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.52 / $73.36 / $159.44
| Professional | | $47.52 | $73.36 | $159.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.94 / $56.02 / $116.14
| Professional | | $40.94 | $56.02 | $116.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.88 / $30.88 / $94.48
| Facility | 26 | $30.88 | $30.88 | $94.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.27 / $65.62 / $130.97
| Professional | | $49.27 | $65.62 | $130.97 |