- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.72 / $79.25 / $146.91
| Facility | 26 | $40.72 | $79.25 | $146.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $79.23 / $81.61 / $83.98
| Facility | 26 | $79.23 | $81.61 | $83.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.24 / $49.17 / $208.88
| Professional | 26 | $36.24 | $49.17 | $208.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $92.41 / $175.59 / $175.59
| Facility | 26 | $92.41 | $175.59 | $175.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.61 / $83.98 / $217.08
| Facility | 26 | $81.61 | $83.98 | $217.08 |