- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.17 / $100.48 / $100.48
| Facility | 26 | $37.17 | $100.48 | $100.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.60 / $56.95 / $171.74
| Professional | | $42.60 | $56.95 | $171.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.22 / $85.48 / $120.88
| Professional | | $58.22 | $85.48 | $120.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.34 / $121.48 / $181.65
| Professional | | $75.34 | $121.48 | $181.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.05 / $109.64 / $219.55
| Professional | | $63.05 | $109.64 | $219.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.56 / $76.88 / $124.18
| Professional | | $67.56 | $76.88 | $124.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.90 / $56.28 / $82.73
| Professional | | $46.90 | $56.28 | $82.73 |