- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.35 / $22.22 / $37.40
| Facility | 26 | $20.35 | $22.22 | $37.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.70 / $92.08 / $155.00
| Professional | | $82.70 | $92.08 | $155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.00 / $93.00 / $93.00
| Professional | | $93.00 | $93.00 | $93.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.93 / $85.55 / $156.65
| Professional | | $49.93 | $85.55 | $156.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $61.05
| Professional | | $32.34 | $32.34 | $61.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.20 / $81.23 / $146.30
| Professional | | $46.20 | $81.23 | $146.30 |