- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.46 / $22.46 / $116.13
| Facility | 26 | $22.46 | $22.46 | $116.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.93 / $65.73 / $147.27
| Professional | | $58.93 | $65.73 | $147.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.45 / $29.45 / $55.19
| Professional | | $29.45 | $29.45 | $55.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.76 / $102.72 / $166.80
| Professional | | $57.76 | $102.72 | $166.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.12 / $94.91 / $203.89
| Professional | | $78.12 | $94.91 | $203.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.82 / $71.54 / $119.38
| Professional | | $51.82 | $71.54 | $119.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.40 / $82.45 / $141.26
| Professional | | $52.40 | $82.45 | $141.26 |