- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $5.38 / $9.30 / $21.68
| Facility | 26 | $5.38 | $9.30 | $21.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.21 / $51.71 / $89.52
| Professional | | $41.21 | $51.71 | $89.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.26 / $75.33 / $99.48
| Professional | | $44.26 | $75.33 | $99.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.43 / $97.17 / $155.08
| Professional | | $55.43 | $97.17 | $155.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.02 / $81.47 / $97.64
| Professional | | $57.02 | $81.47 | $97.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.46 / $72.25 / $141.38
| Professional | | $47.46 | $72.25 | $141.38 |