- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $124.60 / $301.44 / $376.77
| Facility | 26 | $124.60 | $301.44 | $376.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.63 / $155.00 / $524.91
| Professional | 26 | $93.63 | $155.00 | $524.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.41 / $88.55 / $428.92
| Professional | 26 | $66.41 | $88.55 | $428.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.43 / $117.01 / $188.15
| Professional | 26 | $62.43 | $117.01 | $188.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $834.64 / $834.64 / $960.00
| Facility | 26 | $834.64 | $834.64 | $960.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.04 / $87.39 / $1,192.32
| Professional | 26 | $79.04 | $87.39 | $1,192.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.04 / $82.88 / $179.83
| Professional | 26 | $79.04 | $82.88 | $179.83 |