- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.00 / $320.10 / $413.68
| Facility | 26 | $135.00 | $320.10 | $413.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.63 / $135.00 / $470.31
| Professional | 26 | $93.63 | $135.00 | $470.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $88.17 / $160.74 / $211.69
| Professional | 26 | $88.17 | $160.74 | $211.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.97 / $128.55 / $230.21
| Professional | 26 | $98.97 | $128.55 | $230.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $99.54 / $100.63 / $102.20
| Professional | 26 | $99.54 | $100.63 | $102.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.15 / $129.66 / $191.42
| Professional | 26 | $71.15 | $129.66 | $191.42 |