- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.06 / $72.16 / $132.91
| Facility | 26 | $38.06 | $72.16 | $132.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.33 / $74.50 / $76.67
| Facility | 26 | $72.33 | $74.50 | $76.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.38 / $33.17 / $58.50
| Professional | 26 | $20.38 | $33.17 | $58.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.50 / $129.00 / $129.00
| Facility | 26 | $74.50 | $129.00 | $129.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.50 / $76.67 / $121.32
| Facility | 26 | $74.50 | $76.67 | $121.32 |