- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.39 / $62.09 / $82.71
| Facility | 26 | $20.39 | $62.09 | $82.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.48 / $104.88 / $300.37
| Professional | | $59.48 | $104.88 | $300.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.69 / $177.48 / $240.51
| Professional | | $84.69 | $177.48 | $240.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.20 / $119.36 / $209.63
| Professional | | $84.20 | $119.36 | $209.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.98 / $94.27 / $122.81
| Professional | | $79.98 | $94.27 | $122.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.79 / $28.52 / $51.59
| Professional | | $12.79 | $28.52 | $51.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.17 / $126.94 / $201.33
| Professional | | $77.17 | $126.94 | $201.33 |