- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.59 / $33.05 / $60.64
| Facility | 26 | $25.59 | $33.05 | $60.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.01 / $49.51 / $132.10
| Professional | | $43.01 | $49.51 | $132.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.68 / $30.68 / $30.68
| Facility | 26 | $30.68 | $30.68 | $30.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.25 / $67.59 / $106.38
| Professional | | $47.25 | $67.59 | $106.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.10 / $30.10 / $30.10
| Facility | 26 | $30.10 | $30.10 | $30.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.12 / $73.34 / $119.80
| Professional | | $44.12 | $73.34 | $119.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.31 / $59.50 / $104.28
| Professional | | $47.31 | $59.50 | $104.28 |