- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.75 / $14.45 / $17.78
| Facility | 26 | $11.75 | $14.45 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $50.12 / $93.33
| Professional | | $41.69 | $50.12 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $32.36 / $53.70
| Professional | | $6.76 | $32.36 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.29 / $10.72 / $15.14
| Facility | 26 | $2.29 | $10.72 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $75.86 / $104.71
| Professional | | $52.48 | $75.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $33.11 / $66.07
| Professional | | $20.42 | $33.11 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $75.86 / $109.65
| Professional | | $52.48 | $75.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $83.18 / $120.23
| Professional | | $50.12 | $83.18 | $120.23 |