- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.94 / $21.49 / $45.76
| Facility | 26 | $20.94 | $21.49 | $45.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.83 / $52.57 / $68.70
| Professional | | $33.83 | $52.57 | $68.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.92 / $21.84 / $45.26
| Professional | 26 | $19.92 | $21.84 | $45.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.29 / $52.29 / $52.29
| Professional | | $52.29 | $52.29 | $52.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.04 / $21.04 / $21.04
| Professional | 26 | $21.04 | $21.04 | $21.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.82 / $33.90 / $52.34
| Professional | | $28.82 | $33.90 | $52.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.18 / $22.57 / $32.54
| Professional | 26 | $19.18 | $22.57 | $32.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.61 / $26.66 / $55.73
| Professional | | $18.61 | $26.66 | $55.73 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.51 / $23.51 / $23.51
| Facility | 26 | $23.51 | $23.51 | $23.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.42 / $48.16 / $76.63
| Professional | | $37.42 | $48.16 | $76.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.73 / $30.29 / $46.03
| Professional | 26 | $19.73 | $30.29 | $46.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.88 / $32.34 / $57.95
| Professional | | $19.88 | $32.34 | $57.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.82 / $45.09 / $80.56
| Professional | | $32.82 | $45.09 | $80.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.71 / $25.38 / $41.41
| Professional | 26 | $19.71 | $25.38 | $41.41 |