- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.16 / $33.33 / $38.11
| Facility | 26 | $32.16 | $33.33 | $38.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.17 / $82.38 / $108.71
| Professional | | $66.17 | $82.38 | $108.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.30 / $87.36 / $146.97
| Professional | | $65.30 | $87.36 | $146.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.17 / $35.17 / $35.17
| Facility | 26 | $35.17 | $35.17 | $35.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.02 / $110.34 / $192.23
| Professional | | $70.02 | $110.34 | $192.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.80 / $98.30 / $174.68
| Professional | | $68.80 | $98.30 | $174.68 |