- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.59 / $98.70 / $255.27
| Facility | 26 | $29.59 | $98.70 | $255.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.06 / $84.56 / $204.63
| Professional | | $83.06 | $84.56 | $204.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.39 / $105.39 / $289.56
| Professional | | $105.39 | $105.39 | $289.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.45 / $115.50 / $283.44
| Professional | | $77.45 | $115.50 | $283.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.62 / $108.15 / $208.90
| Professional | | $90.62 | $108.15 | $208.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.36 / $38.61 / $73.42
| Professional | 26 | $33.36 | $38.61 | $73.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.41 / $92.03 / $287.56
| Professional | | $77.41 | $92.03 | $287.56 |