- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.51 / $47.51 / $50.46
| Facility | 26 | $47.51 | $47.51 | $50.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.20 / $105.95 / $127.91
| Professional | | $90.20 | $105.95 | $127.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.28 / $107.59 / $148.47
| Professional | | $83.28 | $107.59 | $148.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.60 / $62.26 / $120.52
| Professional | | $48.60 | $62.26 | $120.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.00 / $127.24 / $239.08
| Professional | | $95.00 | $127.24 | $239.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.72 / $118.38 / $195.27
| Professional | | $86.72 | $118.38 | $195.27 |