- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $181.97 / $338.84
| Facility | 26 | $107.15 | $181.97 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $100.00 / $213.80
| Professional | | $57.54 | $100.00 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Professional | 50 | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $263.03 / $389.05
| Professional | | $85.11 | $263.03 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $128.82 / $398.11 / $588.84
| Professional | 50 | $128.82 | $398.11 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $186.21 / $302.00
| Professional | | $97.72 | $186.21 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $190.55 / $239.88
| Professional | | $107.15 | $190.55 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $123.03 / $223.87
| Professional | | $72.44 | $123.03 | $223.87 |