- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $20.89 / $43.65
| Facility | 26 | $20.89 | $20.89 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $53.70 / $162.18
| Professional | | $33.88 | $53.70 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.95 / $25.70 / $93.33
| Professional | 26 | $19.95 | $25.70 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $51.29 / $141.25
| Facility | 26 | $16.98 | $51.29 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $67.61 / $354.81
| Professional | | $41.69 | $67.61 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.50 / $31.62 / $141.25
| Professional | 26 | $19.50 | $31.62 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.55 / $38.90 / $117.49
| Professional | 26 | $24.55 | $38.90 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $77.62 / $186.21
| Professional | | $45.71 | $77.62 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.44 / $34.67 / $75.86
| Professional | 26 | $23.44 | $34.67 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $34.67 / $77.62
| Professional | | $15.49 | $34.67 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $85.11 / $144.54
| Professional | | $53.70 | $85.11 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.39 / $35.48 / $60.26
| Professional | 26 | $22.39 | $35.48 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $74.13 / $74.13
| Professional | | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $51.29 / $141.25
| Facility | 26 | $16.98 | $51.29 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $69.18 / $354.81
| Professional | | $41.69 | $69.18 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.42 / $32.36 / $141.25
| Professional | 26 | $20.42 | $32.36 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $67.61 / $154.88
| Professional | | $42.66 | $67.61 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.39 / $33.88 / $64.57
| Professional | 26 | $22.39 | $33.88 | $64.57 |