- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.89 / $194.75 / $380.45
| Facility | 26 | $44.89 | $194.75 | $380.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.01 / $110.72 / $265.70
| Professional | | $105.01 | $110.72 | $265.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.96 / $133.96 / $336.73
| Professional | | $133.96 | $133.96 | $336.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.37 / $151.12 / $373.19
| Professional | | $102.37 | $151.12 | $373.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.54 / $145.90 / $277.45
| Professional | | $122.54 | $145.90 | $277.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.79 / $57.71 / $109.75
| Professional | 26 | $49.79 | $57.71 | $109.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.47 / $120.18 / $381.93
| Professional | | $97.47 | $120.18 | $381.93 |