- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.42 / $9.60 / $12.39
| Facility | 26 | $9.42 | $9.60 | $12.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.36 / $45.55 / $70.56
| Professional | | $43.36 | $45.55 | $70.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.37 / $56.76 / $101.11
| Professional | | $47.37 | $56.76 | $101.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.55 / $12.41 / $58.35
| Professional | | $8.55 | $12.41 | $58.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.80 / $10.80 / $10.80
| Facility | 26 | $10.80 | $10.80 | $10.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.92 / $73.59 / $130.47
| Professional | | $44.92 | $73.59 | $130.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.81 / $32.34 / $52.38
| Professional | | $13.81 | $32.34 | $52.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.83 / $65.20 / $112.38
| Professional | | $45.83 | $65.20 | $112.38 |