- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $140.75 / $375.00 / $392.35
| Facility | 26 | $140.75 | $375.00 | $392.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $94.99 / $265.00 / $375.00
| Professional | 26 | $94.99 | $265.00 | $375.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.94 / $118.45 / $209.39
| Professional | 26 | $80.94 | $118.45 | $209.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $92.41 / $160.40 / $265.01
| Professional | 26 | $92.41 | $160.40 | $265.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $96.37 / $122.77 / $229.23
| Professional | 26 | $96.37 | $122.77 | $229.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.14 / $119.82 / $190.56
| Professional | 26 | $83.14 | $119.82 | $190.56 |