- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.68 / $26.96 / $34.71
| Facility | 26 | $25.68 | $26.96 | $34.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.58 / $50.49 / $78.81
| Professional | | $41.58 | $50.49 | $78.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.62 / $71.64 / $102.34
| Professional | | $52.62 | $71.64 | $102.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.10 / $30.10 / $30.10
| Facility | 26 | $30.10 | $30.10 | $30.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.71 / $63.07 / $119.80
| Professional | | $43.71 | $63.07 | $119.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.97 / $88.97 / $93.31
| Professional | | $88.97 | $88.97 | $93.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.11 / $74.06 / $105.80
| Professional | | $60.11 | $74.06 | $105.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.10 / $39.54 / $56.50
| Professional | 26 | $32.10 | $39.54 | $56.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.38 / $79.58 / $119.95
| Professional | | $53.38 | $79.58 | $119.95 |