- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.18 / $26.18 / $54.08
| Facility | 26 | $26.18 | $26.18 | $54.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.95 / $89.23 / $116.60
| Professional | | $41.95 | $89.23 | $116.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.18 / $44.85 / $56.29
| Professional | 26 | $26.18 | $44.85 | $56.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.68 / $54.76 / $104.58
| Professional | | $32.68 | $54.76 | $104.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.72 / $110.45 / $163.27
| Professional | | $51.72 | $110.45 | $163.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.76 / $57.49 / $84.99
| Professional | 26 | $31.76 | $57.49 | $84.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $42.18 / $95.52
| Professional | | $32.34 | $42.18 | $95.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.49 / $115.25 / $168.74
| Professional | | $54.49 | $115.25 | $168.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.76 / $59.99 / $84.99
| Professional | 26 | $31.76 | $59.99 | $84.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.16 / $99.55 / $163.02
| Professional | | $63.16 | $99.55 | $163.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.81 / $50.87 / $88.75
| Professional | 26 | $36.81 | $50.87 | $88.75 |