- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.58 / $54.37 / $69.34
| Facility | 26 | $31.58 | $54.37 | $69.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.89 / $104.60 / $172.25
| Professional | | $76.89 | $104.60 | $172.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.75 / $75.75 / $75.75
| Professional | | $75.75 | $75.75 | $75.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.00 / $149.00 / $149.00
| Professional | | $149.00 | $149.00 | $149.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.56 / $115.50 / $182.74
| Professional | | $67.56 | $115.50 | $182.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $42.16
| Professional | | $32.34 | $32.34 | $42.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.62 / $98.46 / $174.86
| Professional | | $73.62 | $98.46 | $174.86 |