- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.82 / $19.17 / $28.36
| Facility | 26 | $16.82 | $19.17 | $28.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.84 / $86.03 / $108.27
| Professional | | $71.84 | $86.03 | $108.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.59 / $73.38 / $116.67
| Professional | | $66.59 | $73.38 | $116.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.82 / $74.11 / $109.84
| Professional | | $17.82 | $74.11 | $109.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.81 / $20.81 / $20.81
| Facility | 26 | $20.81 | $20.81 | $20.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.91 / $99.48 / $192.85
| Professional | | $72.91 | $99.48 | $192.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.47 / $88.33 / $146.66
| Professional | | $70.47 | $88.33 | $146.66 |