- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.16 / $28.74 / $158.79
| Facility | 26 | $23.16 | $28.74 | $158.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.11 / $80.89 / $86.99
| Professional | | $61.11 | $80.89 | $86.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.70 / $96.95 / $133.13
| Professional | | $28.70 | $96.95 | $133.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.45 / $75.98 / $126.32
| Professional | | $49.45 | $75.98 | $126.32 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.65 / $66.65 / $127.16
| Facility | 26 | $66.65 | $66.65 | $127.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.94 / $95.66 / $681.03
| Professional | | $65.94 | $95.66 | $681.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.94 / $85.37 / $118.29
| Professional | | $65.94 | $85.37 | $118.29 |