- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $52.48 / $56.23
| Facility | 26 | $51.29 | $52.48 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $194.98 / $269.15
| Professional | | $169.82 | $194.98 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $190.55 / $257.04
| Professional | | $134.90 | $190.55 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $63.10 / $77.62
| Professional | | $40.74 | $63.10 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.59 / $58.88 / $85.11
| Facility | 26 | $12.59 | $58.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $234.42 / $851.14
| Professional | | $144.54 | $234.42 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $89.13
| Professional | | $32.36 | $33.11 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $199.53 / $398.11
| Professional | | $128.82 | $199.53 | $398.11 |