- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.59 / $18.59 / $39.79
| Facility | 26 | $18.59 | $18.59 | $39.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.48 / $123.37 / $123.37
| Professional | | $76.48 | $123.37 | $123.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.25 / $69.26 / $150.07
| Professional | | $18.25 | $69.26 | $150.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.05 / $212.86 / $366.23
| Professional | | $98.05 | $212.86 | $366.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.17 / $32.34 / $123.41
| Professional | | $31.17 | $32.34 | $123.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.29 / $214.20 / $289.95
| Professional | | $127.29 | $214.20 | $289.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.29 / $226.50 / $341.24
| Professional | | $117.29 | $226.50 | $341.24 |