- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.24 / $53.25 / $135.69
| Facility | 26 | $37.24 | $53.25 | $135.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.24 / $324.99 / $553.83
| Professional | | $261.24 | $324.99 | $553.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.29 / $289.30 / $441.50
| Professional | | $240.29 | $289.30 | $441.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.13 / $234.53 / $274.66
| Professional | | $40.13 | $234.53 | $274.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.69 / $378.41 / $699.23
| Professional | | $249.69 | $378.41 | $699.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.18 / $367.00 / $664.94
| Professional | | $262.18 | $367.00 | $664.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.74 / $265.92 / $391.53
| Professional | | $41.74 | $265.92 | $391.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.45 / $326.22 / $614.38
| Professional | | $225.45 | $326.22 | $614.38 |