- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.28 / $77.34 / $202.11
| Facility | 26 | $23.28 | $77.34 | $202.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.99 / $45.99 / $78.81
| Professional | | $45.99 | $45.99 | $78.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.41 / $55.25 / $205.34
| Professional | | $48.41 | $55.25 | $205.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.72 / $79.34 / $162.47
| Professional | | $40.72 | $79.34 | $162.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.31 / $58.37 / $112.61
| Professional | | $49.31 | $58.37 | $112.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.22 / $30.38 / $57.77
| Professional | 26 | $26.22 | $30.38 | $57.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $56.92 / $155.01
| Professional | | $40.74 | $56.92 | $155.01 |