- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.87 / $35.04 / $46.10
| Facility | 26 | $27.87 | $35.04 | $46.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.30 / $78.86 / $120.05
| Professional | | $59.30 | $78.86 | $120.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.55 / $91.55 / $91.55
| Professional | | $91.55 | $91.55 | $91.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.70 / $100.16 / $135.57
| Professional | | $76.70 | $100.16 | $135.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.59 / $72.23 / $127.53
| Professional | | $40.59 | $72.23 | $127.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.50 / $75.45 / $128.69
| Professional | | $52.50 | $75.45 | $128.69 |