- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.81 / $22.81 / $36.29
| Facility | 26 | $22.81 | $22.81 | $36.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.66 / $57.74 / $69.94
| Professional | | $50.66 | $57.74 | $69.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.05 / $56.19 / $77.54
| Professional | | $44.05 | $56.19 | $77.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.82 / $35.61 / $67.31
| Professional | | $22.82 | $35.61 | $67.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.43 / $28.43 / $28.43
| Facility | 26 | $28.43 | $28.43 | $28.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.94 / $71.06 / $104.34
| Professional | | $53.94 | $71.06 | $104.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.23 / $60.44 / $105.17
| Professional | | $51.23 | $60.44 | $105.17 |