- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.88 / $57.54 / $165.96
| Facility | 26 | $33.88 | $57.54 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $199.53 / $602.56
| Professional | | $138.04 | $199.53 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $38.02 / $38.02
| Facility | 26 | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $177.83 / $354.81
| Professional | | $120.23 | $177.83 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $45.71 / $109.65
| Facility | 26 | $8.51 | $45.71 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $199.53 / $436.52
| Professional | | $138.04 | $199.53 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $169.82 / $331.13
| Professional | | $125.89 | $169.82 | $331.13 |