- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $56.23 / $63.10
| Facility | 26 | $51.29 | $56.23 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $95.50 / $177.83
| Professional | | $56.23 | $95.50 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $44.67 / $44.67
| Professional | | $44.67 | $44.67 | $44.67 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $87.10 / $194.98
| Professional | | $72.44 | $87.10 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $107.15 / $229.09
| Professional | | $46.77 | $107.15 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $107.15 / $199.53
| Professional | | $74.13 | $107.15 | $199.53 |