- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.51 / $27.84 / $27.84
| Facility | 26 | $26.51 | $27.84 | $27.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.71 / $131.44 / $213.65
| Professional | | $86.71 | $131.44 | $213.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.08 / $197.24 / $288.06
| Professional | | $129.08 | $197.24 | $288.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.88 / $139.76 / $260.22
| Professional | | $88.88 | $139.76 | $260.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.51 / $245.51 / $263.64
| Professional | | $245.51 | $245.51 | $263.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.52 / $214.99 / $291.95
| Professional | | $172.52 | $214.99 | $291.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.46 / $42.95 / $58.32
| Professional | 26 | $34.46 | $42.95 | $58.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.99 / $194.99 / $300.83
| Professional | | $100.99 | $194.99 | $300.83 |