- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.23 / $18.23 / $38.29
| Facility | 26 | $18.23 | $18.23 | $38.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.65 / $74.12 / $342.61
| Professional | | $45.65 | $74.12 | $342.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.80 / $42.61 / $71.39
| Professional | | $17.80 | $42.61 | $71.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.80 / $76.09 / $102.66
| Professional | | $50.80 | $76.09 | $102.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $52.32
| Professional | | $32.34 | $32.34 | $52.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.94 / $87.59 / $139.78
| Professional | | $52.94 | $87.59 | $139.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.84 / $61.58 / $118.57
| Professional | | $56.84 | $61.58 | $118.57 |