- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.39 / $35.39 / $35.40
| Facility | 26 | $35.39 | $35.39 | $35.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.63 / $226.79 / $241.84
| Professional | | $192.63 | $226.79 | $241.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.01 / $318.02 / $467.68
| Professional | | $235.01 | $318.02 | $467.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.52 / $291.33 / $500.98
| Professional | | $176.52 | $291.33 | $500.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.58 / $399.58 / $429.94
| Professional | | $399.58 | $399.58 | $429.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.99 / $341.26 / $430.08
| Professional | | $215.99 | $341.26 | $430.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.71 / $53.26 / $65.73
| Professional | 26 | $33.71 | $53.26 | $65.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.44 / $375.09 / $610.83
| Professional | | $171.44 | $375.09 | $610.83 |