- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.60 / $129.66 / $162.07
| Facility | 26 | $53.60 | $129.66 | $162.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.81 / $146.56 / $177.89
| Professional | | $64.81 | $146.56 | $177.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.73 / $56.98 / $71.22
| Professional | | $42.73 | $56.98 | $71.22 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.74 / $43.74 / $43.74
| Facility | 26 | $43.74 | $43.74 | $43.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.16 / $150.06 / $225.09
| Professional | | $60.16 | $150.06 | $225.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $143.59 / $143.59 / $143.59
| Professional | 50 | $143.59 | $143.59 | $143.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $89.92 / $327.96 / $327.96
| Facility | 26 | $89.92 | $327.96 | $327.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.03 / $167.18 / $891.97
| Professional | | $86.03 | $167.18 | $891.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.53 / $151.55 / $197.78
| Professional | | $78.53 | $151.55 | $197.78 |