- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.42 / $99.61 / $99.61
| Facility | 26 | $39.42 | $99.61 | $99.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.51 / $47.52 / $132.10
| Professional | | $41.51 | $47.52 | $132.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.58 / $68.39 / $95.88
| Professional | | $46.58 | $68.39 | $95.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.70 / $96.34 / $150.68
| Professional | | $61.70 | $96.34 | $150.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.02 / $83.88 / $164.57
| Professional | | $29.02 | $83.88 | $164.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.72 / $73.81 / $137.54
| Professional | | $58.72 | $73.81 | $137.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.76 / $48.00 / $72.50
| Professional | | $38.76 | $48.00 | $72.50 |