- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.95 / $82.78 / $159.83
| Facility | 26 | $71.95 | $82.78 | $159.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.30 / $140.66 / $193.82
| Professional | | $126.30 | $140.66 | $193.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.00 / $171.58 / $281.91
| Professional | | $131.00 | $171.58 | $281.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $99.42 / $99.42 / $99.48
| Facility | 26 | $99.42 | $99.42 | $99.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.26 / $206.15 / $334.83
| Professional | | $149.26 | $206.15 | $334.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.51 / $187.59 / $297.68
| Professional | | $140.51 | $187.59 | $297.68 |