- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.07 / $3.46 / $3.46
| Facility | 26 | $3.07 | $3.46 | $3.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.67 / $43.88 / $60.64
| Professional | | $37.67 | $43.88 | $60.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.50 / $32.61 / $54.31
| Professional | | $3.50 | $32.61 | $54.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.33 / $61.72 / $77.68
| Professional | | $45.33 | $61.72 | $77.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.58 / $100.00 / $100.00
| Facility | 26 | $8.58 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.84 / $57.69 / $442.90
| Professional | | $42.84 | $57.69 | $442.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.29 / $53.16 / $87.34
| Professional | | $41.29 | $53.16 | $87.34 |