- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $39.81 / $39.81
| Facility | 26 | $38.02 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $72.44 / $257.04
| Professional | | $56.23 | $72.44 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $47.86 / $112.20
| Professional | | $19.50 | $47.86 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $85.11 / $109.65
| Professional | | $58.88 | $85.11 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $117.49
| Professional | | $32.36 | $33.11 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $97.72 / $162.18
| Professional | | $58.88 | $97.72 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $85.11 / $147.91
| Professional | | $66.07 | $85.11 | $147.91 |