- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.90 / $39.81 / $61.66
| Facility | 26 | $38.90 | $39.81 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $72.44 / $190.55
| Professional | | $56.23 | $72.44 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $107.15 / $199.53
| Professional | | $77.62 | $107.15 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $112.20 / $223.87 / $407.38
| Professional | 50 | $112.20 | $223.87 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $141.25 / $275.42
| Professional | | $64.57 | $141.25 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $117.49 / $562.34
| Professional | | $102.33 | $117.49 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $64.57 / $281.84
| Professional | 26 | $56.23 | $64.57 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $72.44 / $109.65
| Professional | | $67.61 | $72.44 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $158.49 / $263.03
| Professional | | $93.33 | $158.49 | $263.03 |