- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.64 / $16.64 / $28.03
| Facility | 26 | $16.64 | $16.64 | $28.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.10 / $62.71 / $88.53
| Professional | | $50.10 | $62.71 | $88.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.00 / $57.00 / $57.00
| Professional | | $57.00 | $57.00 | $57.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.67 / $67.50 / $96.42
| Professional | | $50.67 | $67.50 | $96.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.30 / $57.75 / $89.02
| Professional | | $46.30 | $57.75 | $89.02 |