- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.71 / $21.71 / $36.54
| Facility | 26 | $21.71 | $21.71 | $36.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.81 / $82.03 / $120.01
| Professional | | $68.81 | $82.03 | $120.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.00 / $82.00 / $82.00
| Professional | | $82.00 | $82.00 | $82.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.43 / $92.55 / $132.21
| Professional | | $68.43 | $92.55 | $132.21 |
- 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
- $62.27 / $78.70 / $118.32
| Professional | | $62.27 | $78.70 | $118.32 |