- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.39 / $67.26 / $248.73
| Facility | 26 | $38.39 | $67.26 | $248.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.62 / $146.56 / $186.77
| Professional | | $64.62 | $146.56 | $186.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $89.92 / $96.47 / $327.96
| Facility | 26 | $89.92 | $96.47 | $327.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.27 / $159.88 / $918.73
| Professional | | $78.27 | $159.88 | $918.73 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $60.83 / $60.83 / $191.79
| Professional | 50 | $60.83 | $60.83 | $191.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.52 / $180.10 / $351.18
| Professional | | $88.52 | $180.10 | $351.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.15 / $61.22 / $131.81
| Professional | | $39.15 | $61.22 | $131.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.72 / $157.33 / $217.45
| Professional | | $77.72 | $157.33 | $217.45 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $89.92 / $327.96 / $327.96
| Facility | 26 | $89.92 | $327.96 | $327.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.77 / $174.34 / $918.73
| Professional | | $94.77 | $174.34 | $918.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.31 / $128.19 / $250.95
| Professional | | $94.31 | $128.19 | $250.95 |