- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.02 / $10.03 / $17.22
| Facility | 26 | $10.02 | $10.03 | $17.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.24 / $52.72 / $73.80
| Professional | | $43.24 | $52.72 | $73.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.88 / $78.09 / $149.38
| Professional | | $54.88 | $78.09 | $149.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.71 / $67.97 / $96.38
| Professional | | $55.71 | $67.97 | $96.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.33 / $57.48 / $116.37
| Professional | | $42.33 | $57.48 | $116.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.74 / $62.77 / $119.20
| Professional | | $39.74 | $62.77 | $119.20 |