- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $7.08 / $13.18
| Facility | 26 | $7.08 | $7.08 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $32.36 / $61.66
| Professional | | $25.70 | $32.36 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $52.48 / $52.48
| Professional | | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $42.66 / $66.07
| Professional | | $25.12 | $42.66 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $35.48 / $60.26
| Professional | | $22.91 | $35.48 | $60.26 |