- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.39 / $21.39 / $29.31
| Facility | 26 | $21.39 | $21.39 | $29.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.67 / $56.95 / $184.41
| Professional | | $51.67 | $56.95 | $184.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.19 / $64.41 / $73.62
| Professional | | $60.19 | $64.41 | $73.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.68 / $72.86 / $139.44
| Professional | | $47.68 | $72.86 | $139.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.13 / $73.73 / $111.30
| Professional | | $62.13 | $73.73 | $111.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.83 / $30.11 / $45.27
| Professional | 26 | $24.83 | $30.11 | $45.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.22 / $60.27 / $105.34
| Professional | | $49.22 | $60.27 | $105.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.70 / $67.01 / $88.53
| Professional | | $49.70 | $67.01 | $88.53 |