- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.15 / $154.69 / $209.37
| Facility | 26 | $50.15 | $154.69 | $209.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.43 / $268.91 / $668.89
| Professional | | $191.43 | $268.91 | $668.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.80 / $344.65 / $406.36
| Professional | | $221.80 | $344.65 | $406.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.75 / $324.56 / $542.49
| Professional | | $267.75 | $324.56 | $542.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.20 / $249.10 / $301.42
| Professional | | $235.20 | $249.10 | $301.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.00 / $68.12 / $124.53
| Professional | | $65.00 | $68.12 | $124.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.87 / $346.21 / $628.91
| Professional | | $181.87 | $346.21 | $628.91 |