- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.05 / $33.52 / $55.15
| Facility | 26 | $28.05 | $33.52 | $55.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.00 / $59.83 / $70.27
| Professional | | $57.00 | $59.83 | $70.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.25 / $88.25 / $88.25
| Professional | | $88.25 | $88.25 | $88.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.17 / $73.19 / $103.75
| Professional | | $49.17 | $73.19 | $103.75 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.32 / $54.32 / $104.46
| Facility | 26 | $54.32 | $54.32 | $104.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.25 / $72.59 / $393.85
| Professional | | $59.25 | $72.59 | $393.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.56 / $66.30 / $102.46
| Professional | | $58.56 | $66.30 | $102.46 |