- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.95 / $26.59 / $26.59
| Facility | 26 | $25.95 | $26.59 | $26.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.22 / $165.94 / $184.50
| Professional | | $143.22 | $165.94 | $184.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.21 / $144.55 / $198.49
| Professional | | $30.21 | $144.55 | $198.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.63 / $153.40 / $229.84
| Professional | | $84.63 | $153.40 | $229.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $62.95 / $122.62 / $122.62
| Facility | 26 | $62.95 | $122.62 | $122.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.24 / $164.03 / $1,185.08
| Professional | | $115.24 | $164.03 | $1,185.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.04 / $142.04 / $272.70
| Professional | | $114.04 | $142.04 | $272.70 |