- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.98 / $14.98 / $44.49
| Facility | 26 | $14.98 | $14.98 | $44.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.95 / $51.15 / $85.27
| Professional | | $44.95 | $51.15 | $85.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.09 / $50.94 / $101.31
| Professional | | $49.09 | $50.94 | $101.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.90 / $15.90 / $15.90
| Facility | 26 | $15.90 | $15.90 | $15.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.64 / $63.26 / $106.63
| Professional | | $48.64 | $63.26 | $106.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.77 / $76.45 / $100.53
| Professional | | $54.77 | $76.45 | $100.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.98 / $24.83 / $44.49
| Facility | 26 | $14.98 | $24.83 | $44.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.47 / $58.99 / $163.99
| Professional | | $45.47 | $58.99 | $163.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.25 / $64.50 / $131.40
| Professional | | $20.25 | $64.50 | $131.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.90 / $15.90 / $15.90
| Facility | 26 | $15.90 | $15.90 | $15.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.62 / $63.06 / $106.63
| Professional | | $48.62 | $63.06 | $106.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.66 / $13.66 / $17.00
| Facility | 26 | $13.66 | $13.66 | $17.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.84 / $46.53 / $53.00
| Professional | | $45.84 | $46.53 | $53.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.29 / $55.10 / $96.39
| Professional | | $44.29 | $55.10 | $96.39 |