- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.44 / $34.31 / $69.98
| Facility | 26 | $18.44 | $34.31 | $69.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.48 / $80.65 / $222.87
| Professional | | $59.48 | $80.65 | $222.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.66 / $128.69 / $182.00
| Professional | | $87.66 | $128.69 | $182.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.14 / $153.26 / $287.39
| Professional | | $109.14 | $153.26 | $287.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.35 / $178.34 / $330.56
| Professional | | $100.35 | $178.34 | $330.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.34 / $113.86 / $193.72
| Professional | | $79.34 | $113.86 | $193.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.26 / $84.74 / $127.98
| Professional | | $66.26 | $84.74 | $127.98 |