- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.93 / $82.08 / $102.60
| Facility | 26 | $33.93 | $82.08 | $102.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.95 / $61.48 / $124.67
| Professional | | $50.95 | $61.48 | $124.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.94 / $47.94 / $47.94
| Professional | | $47.94 | $47.94 | $47.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.01 / $53.34 / $66.68
| Professional | | $40.01 | $53.34 | $66.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.43 / $28.43 / $28.43
| Facility | 26 | $28.43 | $28.43 | $28.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.14 / $71.81 / $113.35
| Professional | | $51.14 | $71.81 | $113.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.32 / $104.46 / $104.46
| Facility | 26 | $54.32 | $104.46 | $104.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.84 / $63.34 / $393.85
| Professional | | $56.84 | $63.34 | $393.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.84 / $61.48 / $100.20
| Professional | | $56.84 | $61.48 | $100.20 |