- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.18 / $43.36 / $55.30
| Facility | 26 | $25.18 | $43.36 | $55.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.52 / $52.27 / $98.00
| Professional | | $43.52 | $52.27 | $98.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.00 / $96.00 / $96.00
| Professional | | $96.00 | $96.00 | $96.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.44 / $67.14 / $100.69
| Professional | | $39.44 | $67.14 | $100.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.74 / $32.34 / $32.34
| Professional | | $21.74 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.44 / $58.36 / $107.91
| Professional | | $39.44 | $58.36 | $107.91 |