- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.07 / $92.54 / $121.24
| Facility | 26 | $31.07 | $92.54 | $121.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.36 / $59.89 / $286.91
| Professional | | $42.36 | $59.89 | $286.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.77 / $72.11 / $93.89
| Professional | | $48.77 | $72.11 | $93.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.02 / $93.23 / $130.57
| Professional | | $59.02 | $93.23 | $130.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.47 / $60.05 / $93.81
| Professional | | $51.47 | $60.05 | $93.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.86 / $76.50 / $83.82
| Professional | | $40.86 | $76.50 | $83.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.86 / $70.17 / $125.21
| Professional | | $45.86 | $70.17 | $125.21 |