- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.38 / $13.14 / $17.09
| Facility | 26 | $10.38 | $13.14 | $17.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.64 / $47.73 / $73.80
| Professional | | $43.64 | $47.73 | $73.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $40.65 / $40.65
| Professional | | $40.65 | $40.65 | $40.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.27 / $48.02 / $96.29
| Professional | | $46.27 | $48.02 | $96.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.80 / $10.80 / $10.80
| Facility | 26 | $10.80 | $10.80 | $10.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.57 / $72.84 / $127.31
| Professional | | $47.57 | $72.84 | $127.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.61 / $73.08 / $96.17
| Professional | | $51.61 | $73.08 | $96.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.57 / $53.57 / $53.60
| Professional | | $53.57 | $53.57 | $53.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.38 / $13.14 / $17.09
| Facility | 26 | $10.38 | $13.14 | $17.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.68 / $52.92 / $86.55
| Professional | | $43.68 | $52.92 | $86.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.75 / $84.34 / $124.80
| Professional | | $13.75 | $84.34 | $124.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.80 / $10.80 / $10.80
| Facility | 26 | $10.80 | $10.80 | $10.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.99 / $69.80 / $125.72
| Professional | | $45.99 | $69.80 | $125.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.30 / $9.30 / $10.50
| Facility | 26 | $9.30 | $9.30 | $10.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.02 / $44.69 / $105.00
| Professional | | $44.02 | $44.69 | $105.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $59.32 / $109.35
| Professional | | $43.65 | $59.32 | $109.35 |