- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.16 / $70.56 / $79.13
| Facility | 26 | $29.16 | $70.56 | $79.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.87 / $82.38 / $108.71
| Professional | | $74.87 | $82.38 | $108.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.31 / $83.69 / $138.09
| Professional | | $75.31 | $83.69 | $138.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.54 / $219.56 / $346.74
| Professional | | $75.54 | $219.56 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.43 / $193.76 / $193.76
| Professional | | $85.43 | $193.76 | $193.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.23 / $68.77 / $68.77
| Professional | 26 | $31.23 | $68.77 | $68.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.41 / $123.48 / $245.36
| Professional | | $58.41 | $123.48 | $245.36 |