- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.59 / $42.62 / $47.41
| Facility | 26 | $35.59 | $42.62 | $47.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.67 / $90.36 / $191.08
| Professional | | $59.67 | $90.36 | $191.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.42 / $51.42 / $61.70
| Professional | | $51.42 | $51.42 | $61.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.26 / $95.64 / $106.27
| Professional | | $72.26 | $95.64 | $106.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.99 / $40.52 / $80.53
| Professional | | $26.99 | $40.52 | $80.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.27 / $98.86 / $154.16
| Professional | | $58.27 | $98.86 | $154.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.50 / $82.18 / $141.57
| Professional | | $63.50 | $82.18 | $141.57 |