- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $67.18 / $69.87 / $386.64
| Facility | 26 | $67.18 | $69.87 | $386.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $118.75 / $200.00
| Professional | 26 | $100.00 | $118.75 | $200.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.39 / $68.76 / $110.71
| Professional | 26 | $60.39 | $68.76 | $110.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $497.44 / $642.55 / $642.55
| Facility | 26 | $497.44 | $642.55 | $642.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.28 / $65.94 / $145.41
| Professional | 26 | $51.28 | $65.94 | $145.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.28 / $61.12 / $88.08
| Professional | 26 | $51.28 | $61.12 | $88.08 |