- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.91 / $72.44 / $85.11
| Facility | 26 | $22.91 | $72.44 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $102.33 / $281.84
| Professional | | $66.07 | $102.33 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $165.96 / $234.42
| Professional | | $66.07 | $165.96 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $125.89 / $218.78
| Professional | | $77.62 | $125.89 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $95.50 / $128.82
| Professional | | $79.43 | $95.50 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $26.30 / $37.15
| Professional | | $12.88 | $26.30 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $107.15 / $186.21
| Professional | | $70.79 | $107.15 | $186.21 |