- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.69 / $21.69 / $116.45
| Facility | 26 | $21.69 | $21.69 | $116.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.18 / $115.96 / $153.68
| Professional | | $86.18 | $115.96 | $153.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.96 / $17.96 / $17.96
| Facility | 26 | $17.96 | $17.96 | $17.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.46 / $127.97 / $221.59
| Professional | | $91.46 | $127.97 | $221.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.82 / $169.94 / $249.71
| Professional | | $126.82 | $169.94 | $249.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.89 / $124.58 / $164.11
| Professional | | $105.89 | $124.58 | $164.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.73 / $130.61 / $227.90
| Professional | | $81.73 | $130.61 | $227.90 |