- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.90 / $10.35 / $25.83
| Facility | 26 | $7.90 | $10.35 | $25.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.87 / $31.86 / $44.42
| Professional | | $26.87 | $31.86 | $44.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.47 / $20.47 / $20.47
| Professional | | $20.47 | $20.47 | $20.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.15 / $51.88 / $63.60
| Professional | | $33.15 | $51.88 | $63.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.25 / $9.25 / $9.25
| Facility | 26 | $9.25 | $9.25 | $9.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.03 / $42.21 / $65.52
| Professional | | $25.03 | $42.21 | $65.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $46.05 / $57.90
| Professional | | $38.90 | $46.05 | $57.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.90 / $14.46 / $25.83
| Facility | 26 | $7.90 | $14.46 | $25.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.02 / $32.83 / $66.40
| Professional | | $27.02 | $32.83 | $66.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.50 / $32.64 / $55.74
| Professional | | $8.50 | $32.64 | $55.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.25 / $9.25 / $9.25
| Facility | 26 | $9.25 | $9.25 | $9.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.91 / $42.00 / $66.09
| Professional | | $25.91 | $42.00 | $66.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.96 / $7.96 / $9.64
| Facility | 26 | $7.96 | $7.96 | $9.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.21 / $31.67 / $37.06
| Professional | | $31.21 | $31.67 | $37.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.17 / $37.00 / $62.76
| Professional | | $25.17 | $37.00 | $62.76 |