- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $61.99 / $106.73 / $136.13
| Facility | 26 | $61.99 | $106.73 | $136.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.98 / $114.67 / $144.59
| Professional | | $83.98 | $114.67 | $144.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.95 / $62.65 / $106.73
| Professional | 26 | $58.95 | $62.65 | $106.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.00 / $282.00 / $282.00
| Professional | | $282.00 | $282.00 | $282.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.51 / $122.91 / $262.85
| Professional | | $79.51 | $122.91 | $262.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.33 / $89.08 / $130.41
| Professional | 26 | $57.33 | $89.08 | $130.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.09 / $107.47 / $334.99
| Professional | | $81.09 | $107.47 | $334.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.11 / $78.70 / $136.76
| Professional | 26 | $55.11 | $78.70 | $136.76 |