- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.82 / $22.24 / $37.52
| Facility | 26 | $20.82 | $22.24 | $37.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.07 / $53.28 / $85.40
| Professional | | $34.07 | $53.28 | $85.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.44 / $22.24 / $33.50
| Professional | 26 | $20.44 | $22.24 | $33.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.79 / $39.79 / $39.79
| Professional | 26 | $39.79 | $39.79 | $39.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Professional | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.16 / $36.06 / $71.69
| Professional | 26 | $20.16 | $36.06 | $71.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.30 / $24.30 / $24.30
| Facility | 26 | $24.30 | $24.30 | $24.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.86 / $64.73 / $117.54
| Professional | | $40.86 | $64.73 | $117.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.61 / $33.79 / $60.02
| Professional | 26 | $24.61 | $33.79 | $60.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.49 / $25.75 / $48.38
| Facility | 26 | $23.49 | $25.75 | $48.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $31.00 / $51.00
| Professional | | $20.00 | $31.00 | $51.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.15 / $45.96 / $81.81
| Professional | | $33.15 | $45.96 | $81.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.40 / $46.65 / $87.09
| Professional | | $33.40 | $46.65 | $87.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.92 / $26.11 / $55.96
| Professional | 26 | $19.92 | $26.11 | $55.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.69 / $80.00 / $106.12
| Facility | 26 | $50.69 | $80.00 | $106.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.79 / $352.79 / $426.98
| Professional | | $352.79 | $352.79 | $426.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $140.68 / $140.68 / $171.23
| Professional | 26 | $140.68 | $140.68 | $171.23 |