- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.65 / $46.77 / $48.98
| Facility | 26 | $43.65 | $46.77 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $245.47 / $489.78
| Professional | | $181.97 | $245.47 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $147.91 / $251.19
| Professional | | $24.55 | $147.91 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $323.59 / $478.63
| Professional | | $234.42 | $323.59 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $169.82
| Professional | | $32.36 | $33.11 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $316.23 / $478.63
| Professional | | $165.96 | $316.23 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $181.97 / $407.38
| Professional | | $169.82 | $181.97 | $407.38 |