- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.69 / $44.16 / $57.27
| Facility | 26 | $35.69 | $44.16 | $57.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.63 / $130.12 / $191.83
| Professional | | $98.63 | $130.12 | $191.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.95 / $93.95 / $165.59
| Professional | | $93.95 | $93.95 | $165.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.84 / $154.16 / $222.54
| Professional | | $139.84 | $154.16 | $222.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.73 / $111.99 / $194.02
| Professional | | $66.73 | $111.99 | $194.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.39 / $119.13 / $190.18
| Professional | | $87.39 | $119.13 | $190.18 |