- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.65 / $15.74 / $17.77
| Facility | 26 | $14.65 | $15.74 | $17.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.63 / $60.70 / $88.26
| Professional | | $48.63 | $60.70 | $88.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.47 / $64.56 / $92.51
| Professional | | $51.47 | $64.56 | $92.51 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.27 / $14.27 / $14.27
| Facility | 26 | $14.27 | $14.27 | $14.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.11 / $65.18 / $102.86
| Professional | | $51.11 | $65.18 | $102.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.60 / $54.50 / $92.92
| Professional | | $43.60 | $54.50 | $92.92 |