- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.00 / $411.96 / $534.75
| Facility | 26 | $135.00 | $411.96 | $534.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.63 / $135.00 / $512.00
| Professional | 26 | $93.63 | $135.00 | $512.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $114.76 / $205.85 / $269.07
| Professional | 26 | $114.76 | $205.85 | $269.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $126.61 / $165.47 / $299.47
| Professional | 26 | $126.61 | $165.47 | $299.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $128.24 / $128.65 / $131.66
| Professional | 26 | $128.24 | $128.65 | $131.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $101.49 / $167.61 / $247.45
| Professional | 26 | $101.49 | $167.61 | $247.45 |