- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.58 / $27.91 / $27.91
| Facility | 26 | $26.58 | $27.91 | $27.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.04 / $125.97 / $192.87
| Professional | | $87.04 | $125.97 | $192.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.22 / $191.26 / $275.18
| Professional | | $132.22 | $191.26 | $275.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.66 / $143.54 / $253.21
| Professional | | $85.66 | $143.54 | $253.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.04 / $233.04 / $250.25
| Professional | | $233.04 | $233.04 | $250.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.76 / $204.07 / $277.13
| Professional | | $163.76 | $204.07 | $277.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.54 / $43.06 / $58.48
| Professional | 26 | $34.54 | $43.06 | $58.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.98 / $195.42 / $325.70
| Professional | | $104.98 | $195.42 | $325.70 |