- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $48.98 / $933.25
| Facility | 26 | $25.12 | $48.98 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $69.18 / $186.21
| Professional | | $46.77 | $69.18 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Professional | 50 | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $43.65 / $74.13
| Facility | 26 | $9.33 | $43.65 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $131.83 / $257.04
| Professional | | $48.98 | $131.83 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $91.20 / $91.20 / $91.20
| Facility | 26 | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $134.90 / $218.78
| Professional | | $48.98 | $134.90 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $34.67 / $69.18
| Professional | | $26.92 | $34.67 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $123.03 / $199.53
| Professional | | $70.79 | $123.03 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $67.61
| Professional | | $60.26 | $60.26 | $67.61 |