- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.00 / $302.50 / $721.08
| Facility | 26 | $125.00 | $302.50 | $721.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $125.00 / $125.00 / $250.37
| Professional | 26 | $125.00 | $125.00 | $250.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $122.01 / $127.90 / $142.65
| Professional | 26 | $122.01 | $127.90 | $142.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.77 / $194.25 / $549.16
| Professional | 26 | $95.77 | $194.25 | $549.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $113.72 / $248.01 / $248.01
| Professional | 26 | $113.72 | $248.01 | $248.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.20 / $161.38 / $369.54
| Professional | 26 | $85.20 | $161.38 | $369.54 |