- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $234.95 / $234.95 / $234.95
| Facility | 26 | $234.95 | $234.95 | $234.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.50 / $171.78 / $259.66
| Professional | | $165.50 | $171.78 | $259.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.50 / $39.26 / $39.26
| Professional | 26 | $35.50 | $39.26 | $39.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.19 / $319.19 / $556.29
| Professional | | $319.19 | $319.19 | $556.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.11 / $44.44 / $71.15
| Professional | 26 | $31.11 | $44.44 | $71.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.49 / $613.58 / $621.54
| Professional | | $332.49 | $613.58 | $621.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.29 / $74.45 / $78.61
| Professional | 26 | $46.29 | $74.45 | $78.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.35 / $224.10 / $512.22
| Professional | | $113.35 | $224.10 | $512.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.60 / $47.31 / $65.38
| Professional | 26 | $28.60 | $47.31 | $65.38 |