- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.99 / $39.59 / $50.49
| Facility | 26 | $22.99 | $39.59 | $50.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.00 / $147.81 / $207.10
| Professional | | $62.00 | $147.81 | $207.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.71 / $22.99 / $44.50
| Professional | 26 | $15.71 | $22.99 | $44.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.50 / $19.28 / $43.96
| Professional | 26 | $13.50 | $19.28 | $43.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.00 / $175.00 / $175.00
| Professional | | $175.00 | $175.00 | $175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.12 / $145.96 / $216.40
| Professional | | $64.12 | $145.96 | $216.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.88 / $28.83 / $44.93
| Professional | 26 | $17.88 | $28.83 | $44.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $60.21
| Professional | | $32.34 | $32.34 | $60.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.59 / $93.09 / $320.20
| Professional | | $66.59 | $93.09 | $320.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.59 / $24.70 / $38.27
| Professional | 26 | $14.59 | $24.70 | $38.27 |