- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.44 / $15.44 / $46.45
| Facility | 26 | $15.44 | $15.44 | $46.45 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.65 / $28.48 / $29.31
| Facility | 26 | $27.65 | $28.48 | $29.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.43 / $12.37 / $41.52
| Professional | 26 | $8.43 | $12.37 | $41.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.48 / $80.00 / $80.00
| Facility | 26 | $28.48 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.48 / $29.31 / $50.52
| Facility | 26 | $28.48 | $29.31 | $50.52 |