- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.68 / $27.55 / $52.13
| Facility | 26 | $22.68 | $27.55 | $52.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.64 / $154.52 / $263.75
| Professional | | $105.64 | $154.52 | $263.75 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.57 / $18.57 / $18.57
| Facility | 26 | $18.57 | $18.57 | $18.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.38 / $189.96 / $291.45
| Professional | | $129.38 | $189.96 | $291.45 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.06 / $27.06 / $27.06
| Facility | 26 | $27.06 | $27.06 | $27.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.37 / $110.31 / $250.94
| Professional | | $69.37 | $110.31 | $250.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.73 / $139.08 / $368.78
| Professional | | $69.73 | $139.08 | $368.78 |