- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.77 / $46.77 / $81.28
| Facility | 26 | $46.77 | $46.77 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $123.03 / $234.42
| Professional | | $95.50 | $123.03 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $95.50 / $138.04
| Professional | | $75.86 | $95.50 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Professional | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $151.36 / $234.42
| Professional | | $85.11 | $151.36 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $51.29
| Professional | | $32.36 | $33.11 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $120.23 / $208.93
| Professional | | $95.50 | $120.23 | $208.93 |