- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.15 / $54.58 / $100.83
| Facility | 26 | $24.15 | $54.58 | $100.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.87 / $53.43 / $54.98
| Facility | 26 | $51.87 | $53.43 | $54.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.92 / $23.40 / $89.23
| Professional | 26 | $15.92 | $23.40 | $89.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.43 / $80.00 / $80.00
| Facility | 26 | $53.43 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.43 / $54.98 / $95.34
| Facility | 26 | $53.43 | $54.98 | $95.34 |