- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.00 / $244.50 / $319.20
| Facility | 26 | $135.00 | $244.50 | $319.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.00 / $135.00 / $750.59
| Professional | 26 | $90.00 | $135.00 | $750.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.44 / $118.24 / $162.61
| Professional | 26 | $66.44 | $118.24 | $162.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.50 / $98.73 / $177.21
| Professional | 26 | $87.50 | $98.73 | $177.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.84 / $77.36 / $77.89
| Professional | 26 | $75.84 | $77.36 | $77.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.20 / $100.72 / $147.69
| Professional | 26 | $64.20 | $100.72 | $147.69 |