- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.00 / $350.42 / $412.35
| Facility | 26 | $135.00 | $350.42 | $412.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.00 / $135.00 / $307.48
| Professional | 26 | $90.00 | $135.00 | $307.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.05 / $226.89 / $269.20
| Professional | 26 | $83.05 | $226.89 | $269.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $110.14 / $124.90 / $223.69
| Professional | 26 | $110.14 | $124.90 | $223.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.15 / $98.15 / $98.15
| Professional | 26 | $98.15 | $98.15 | $98.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.16 / $130.11 / $190.81
| Professional | 26 | $83.16 | $130.11 | $190.81 |