- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.30 / $88.04 / $112.82
| Facility | 26 | $28.30 | $88.04 | $112.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.60 / $60.71 / $214.60
| Professional | | $42.60 | $60.71 | $214.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.48 / $134.40 / $183.92
| Professional | | $53.48 | $134.40 | $183.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.41 / $87.67 / $139.69
| Professional | | $69.41 | $87.67 | $139.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.20 / $77.61 / $98.14
| Professional | | $63.20 | $77.61 | $98.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.54 / $38.94 / $48.91
| Professional | | $35.54 | $38.94 | $48.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.96 / $85.05 / $130.60
| Professional | | $54.96 | $85.05 | $130.60 |