- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $49.47 / $49.47 / $61.22
| Facility | 26 | $49.47 | $49.47 | $61.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $88.01 / $102.87
| Professional | | $81.28 | $88.01 | $102.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.06 / $101.06 / $121.28
| Professional | | $101.06 | $101.06 | $121.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.55 / $94.65 / $150.33
| Professional | | $73.55 | $94.65 | $150.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.29 / $55.20 / $101.06
| Professional | | $34.29 | $55.20 | $101.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.78 / $115.54 / $192.01
| Professional | | $90.78 | $115.54 | $192.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.16 / $99.03 / $163.33
| Professional | | $80.16 | $99.03 | $163.33 |