- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $17.38 / $32.36
| Facility | 26 | $14.13 | $17.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $16.98 / $34.67
| Professional | | $12.88 | $16.98 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.79 / $24.55 / $60.26
| Professional | | $14.79 | $24.55 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.24 / $17.38 / $30.20
| Facility | 26 | $3.24 | $17.38 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $25.70 / $57.54
| Professional | | $13.80 | $25.70 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $19.95 / $45.71
| Professional | | $12.59 | $19.95 | $45.71 |