- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $262.95 / $262.95 / $262.95
| Facility | 26 | $262.95 | $262.95 | $262.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.04 / $83.75 / $105.31
| Professional | | $58.04 | $83.75 | $105.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.17 / $42.89 / $59.95
| Professional | 26 | $38.17 | $42.89 | $59.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.81 / $90.38 / $109.31
| Professional | | $76.81 | $90.38 | $109.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.96 / $48.52 / $48.52
| Professional | 26 | $33.96 | $48.52 | $48.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.81 / $112.40 / $162.01
| Professional | | $71.81 | $112.40 | $162.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.10 / $62.91 / $87.99
| Professional | 26 | $48.10 | $62.91 | $87.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.45 / $85.95 / $122.21
| Professional | | $65.45 | $85.95 | $122.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.77 / $52.74 / $73.17
| Professional | 26 | $39.77 | $52.74 | $73.17 |