- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $41.39 / $102.98 / $102.98
| Facility | 26 | $41.39 | $102.98 | $102.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.67 / $65.73 / $182.75
| Professional | | $59.67 | $65.73 | $182.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.63 / $97.83 / $137.16
| Professional | | $66.63 | $97.83 | $137.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.80 / $133.79 / $214.99
| Professional | | $87.80 | $133.79 | $214.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.58 / $135.56 / $251.27
| Professional | | $77.58 | $135.56 | $251.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.05 / $100.32 / $173.54
| Professional | | $83.05 | $100.32 | $173.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.44 / $68.26 / $103.09
| Professional | | $58.44 | $68.26 | $103.09 |