- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.70 / $25.70 / $25.70
| Facility | 26 | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $47.86 / $72.44
| Professional | | $33.88 | $47.86 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.20 / $21.88 / $34.67
| Professional | 26 | $18.20 | $21.88 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $57.54 / $97.72
| Professional | | $42.66 | $57.54 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $30.20 / $60.26
| Professional | 26 | $20.89 | $30.20 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $33.11 / $45.71
| Professional | | $23.99 | $33.11 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $67.61 / $67.61
| Facility | 26 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $83.18 / $107.15
| Professional | | $61.66 | $83.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.62 / $42.66 / $141.25
| Professional | 26 | $31.62 | $42.66 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $77.62 / $89.13
| Professional | | $47.86 | $77.62 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.50 / $32.36 / $44.67
| Professional | 26 | $19.50 | $32.36 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $43.65 / $79.43
| Professional | | $26.30 | $43.65 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $45.71 / $70.79
| Professional | | $34.67 | $45.71 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.20 / $24.55 / $33.88
| Professional | 26 | $18.20 | $24.55 | $33.88 |