- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.09 / $101.09 / $129.99
| Facility | 26 | $32.09 | $101.09 | $129.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.60 / $84.49 / $173.02
| Professional | | $55.60 | $84.49 | $173.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.86 / $110.25 / $168.47
| Professional | | $69.86 | $110.25 | $168.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.58 / $127.63 / $223.44
| Professional | | $79.58 | $127.63 | $223.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.62 / $88.20 / $135.00
| Professional | | $59.62 | $88.20 | $135.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.83 / $81.83 / $81.83
| Professional | | $81.83 | $81.83 | $81.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.58 / $123.43 / $189.23
| Professional | | $67.58 | $123.43 | $189.23 |