- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.60 / $161.46 / $258.50
| Facility | 26 | $95.60 | $161.46 | $258.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.94 / $168.54 / $217.93
| Professional | | $111.94 | $168.54 | $217.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.09 / $243.64 / $388.90
| Professional | | $72.09 | $243.64 | $388.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $108.13 / $379.98 / $583.35
| Professional | 50 | $108.13 | $379.98 | $583.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.84 / $183.70 / $291.14
| Professional | | $97.84 | $183.70 | $291.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.75 / $184.27 / $239.55
| Professional | | $86.75 | $184.27 | $239.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.70 / $131.60 / $259.89
| Professional | | $79.70 | $131.60 | $259.89 |