- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $70.79 / $199.53
| Facility | 26 | $43.65 | $70.79 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $169.82 / $446.68
| Professional | | $95.50 | $169.82 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $58.88 / $58.88
| Facility | 26 | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $138.04 / $239.88
| Professional | | $102.33 | $138.04 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $64.57 / $162.18
| Facility | 26 | $12.02 | $64.57 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $158.49 / $316.23
| Professional | | $97.72 | $158.49 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $128.82 / $234.42
| Professional | | $95.50 | $128.82 | $234.42 |