- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.55 / $40.54 / $51.71
| Facility | 26 | $23.55 | $40.54 | $51.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.09 / $64.05 / $118.00
| Professional | | $49.09 | $64.05 | $118.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.00 / $102.00 / $102.00
| Professional | | $102.00 | $102.00 | $102.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.47 / $81.23 / $115.30
| Professional | | $46.47 | $81.23 | $115.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.27 / $32.34 / $46.85
| Professional | | $26.27 | $32.34 | $46.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.57 / $65.66 / $129.61
| Professional | | $47.57 | $65.66 | $129.61 |