- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.86 / $38.86 / $45.36
| Facility | 26 | $38.86 | $38.86 | $45.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.84 / $163.77 / $213.65
| Professional | | $137.84 | $163.77 | $213.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.47 / $145.47 / $205.10
| Professional | | $145.47 | $145.47 | $205.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.07 / $151.10 / $208.51
| Professional | | $120.07 | $151.10 | $208.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.26 / $114.21 / $164.08
| Professional | | $34.26 | $114.21 | $164.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.51 / $40.51 / $40.51
| Facility | 26 | $40.51 | $40.51 | $40.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.47 / $169.23 / $285.81
| Professional | | $137.47 | $169.23 | $285.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.77 / $163.11 / $282.01
| Professional | | $125.77 | $163.11 | $282.01 |