- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.00 / $408.85 / $530.52
| Facility | 26 | $135.00 | $408.85 | $530.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.63 / $135.00 / $505.66
| Professional | 26 | $93.63 | $135.00 | $505.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $113.87 / $204.11 / $266.95
| Professional | 26 | $113.87 | $204.11 | $266.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $123.74 / $161.63 / $296.22
| Professional | 26 | $123.74 | $161.63 | $296.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $126.23 / $128.11 / $129.62
| Professional | 26 | $126.23 | $128.11 | $129.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.92 / $173.43 / $245.49
| Professional | 26 | $104.92 | $173.43 | $245.49 |