- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.03 / $20.77 / $26.82
| Facility | 26 | $20.03 | $20.77 | $26.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.97 / $84.40 / $127.74
| Professional | | $64.97 | $84.40 | $127.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.10 / $87.55 / $146.91
| Professional | | $42.10 | $87.55 | $146.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.16 / $22.16 / $22.16
| Facility | 26 | $22.16 | $22.16 | $22.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.72 / $102.90 / $191.77
| Professional | | $48.72 | $102.90 | $191.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.87 / $98.43 / $179.45
| Professional | | $45.87 | $98.43 | $179.45 |