- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.99 / $32.99 / $40.47
| Facility | 26 | $32.99 | $32.99 | $40.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.57 / $56.08 / $137.65
| Professional | | $48.57 | $56.08 | $137.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.26 / $32.99 / $36.11
| Professional | 26 | $21.26 | $32.99 | $36.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.66 / $105.44 / $117.15
| Professional | | $79.66 | $105.44 | $117.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.08 / $42.45 / $47.17
| Professional | 26 | $32.08 | $42.45 | $47.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.57 / $158.02 / $158.02
| Professional | | $41.57 | $158.02 | $158.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.46 / $28.27 / $28.27
| Professional | 26 | $15.46 | $28.27 | $28.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.08 / $107.00 / $260.55
| Professional | | $68.08 | $107.00 | $260.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.57 / $33.83 / $58.76
| Professional | 26 | $28.57 | $33.83 | $58.76 |