- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.65 / $67.01 / $124.24
| Facility | 26 | $33.65 | $67.01 | $124.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.15 / $68.13 / $70.12
| Facility | 26 | $66.15 | $68.13 | $70.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.07 / $31.28 / $65.01
| Professional | 26 | $19.07 | $31.28 | $65.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $68.13 / $68.13 / $68.13
| Facility | 26 | $68.13 | $68.13 | $68.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $68.13 / $70.12 / $114.66
| Facility | 26 | $68.13 | $70.12 | $114.66 |