- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.97 / $96.70 / $120.87
| Facility | 26 | $39.97 | $96.70 | $120.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.40 / $95.57 / $190.31
| Professional | | $80.40 | $95.57 | $190.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.53 / $74.53 / $74.53
| Professional | | $74.53 | $74.53 | $74.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.26 / $83.01 / $103.76
| Professional | | $62.26 | $83.01 | $103.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $32.36 / $32.36
| Facility | 26 | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.42 / $116.72 / $180.06
| Professional | | $78.42 | $116.72 | $180.06 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.40 / $127.16 / $127.16
| Facility | 26 | $66.40 | $127.16 | $127.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.54 / $102.93 / $607.26
| Professional | | $92.54 | $102.93 | $607.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.54 / $97.80 / $160.47
| Professional | | $92.54 | $97.80 | $160.47 |