- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.26 / $23.37 / $23.37
| Facility | 26 | $22.26 | $23.37 | $23.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.17 / $85.88 / $108.66
| Professional | | $67.17 | $85.88 | $108.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.15 / $117.99 / $173.51
| Professional | | $82.15 | $117.99 | $173.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.89 / $107.13 / $198.56
| Professional | | $69.89 | $107.13 | $198.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.31 / $151.31 / $161.49
| Professional | | $151.31 | $151.31 | $161.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $132.50 / $179.94
| Professional | | $106.33 | $132.50 | $179.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.94 / $36.06 / $48.97
| Professional | 26 | $28.94 | $36.06 | $48.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.22 / $146.79 / $231.88
| Professional | | $85.22 | $146.79 | $231.88 |