- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.47 / $32.14 / $37.83
| Facility | 26 | $9.47 | $32.14 | $37.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.71 / $35.02 / $80.41
| Professional | | $27.71 | $35.02 | $80.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.78 / $59.49 / $84.09
| Professional | | $31.78 | $59.49 | $84.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.22 / $50.57 / $81.15
| Professional | | $39.22 | $50.57 | $81.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $45.86 / $54.11
| Professional | | $34.67 | $45.86 | $54.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.08 / $50.06 / $101.35
| Professional | | $30.08 | $50.06 | $101.35 |