- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.78 / $17.78 / $20.89
| Facility | 26 | $17.78 | $17.78 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $93.33 / $114.82
| Professional | | $63.10 | $93.33 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $14.13 / $54.95
| Professional | 26 | $12.02 | $14.13 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $87.10 / $173.78
| Professional | | $64.57 | $87.10 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.47 / $17.38 / $26.92
| Professional | 26 | $10.47 | $17.38 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $87.10 / $165.96
| Professional | | $64.57 | $87.10 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $16.22 / $31.62
| Professional | 26 | $12.02 | $16.22 | $31.62 |