- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.78 / $15.89 / $53.66
| Facility | 26 | $10.78 | $15.89 | $53.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.24 / $59.37 / $91.05
| Professional | | $48.24 | $59.37 | $91.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.14 / $56.14 / $56.14
| Professional | | $56.14 | $56.14 | $56.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.46 / $55.97 / $107.35
| Professional | | $45.46 | $55.97 | $107.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.67 / $56.72 / $74.39
| Professional | | $17.67 | $56.72 | $74.39 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.27 / $14.27 / $14.27
| Facility | 26 | $14.27 | $14.27 | $14.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.89 / $86.37 / $179.56
| Professional | | $57.89 | $86.37 | $179.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $73.09 / $115.96
| Professional | | $56.23 | $73.09 | $115.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.65 / $11.65 / $11.65
| Facility | 26 | $11.65 | $11.65 | $11.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.63 / $55.95 / $107.68
| Professional | | $43.63 | $55.95 | $107.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.27 / $14.27 / $14.27
| Facility | 26 | $14.27 | $14.27 | $14.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.34 / $80.73 / $170.98
| Professional | | $57.34 | $80.73 | $170.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.63 / $64.12 / $120.47
| Professional | | $46.63 | $64.12 | $120.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.65 / $15.46 / $48.99
| Facility | 26 | $11.65 | $15.46 | $48.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.65 / $66.72 / $136.40
| Professional | | $48.65 | $66.72 | $136.40 |