- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $194.98 / $489.78
| Facility | 26 | $95.50 | $194.98 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $114.82 / $346.74
| Professional | 26 | $85.11 | $114.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.71 / $151.36 / $263.03
| Professional | 26 | $104.71 | $151.36 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $151.36 / $436.52
| Facility | 26 | $26.92 | $151.36 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $162.18 / $316.23
| Professional | 26 | $95.50 | $162.18 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $128.82 / $245.47
| Professional | 26 | $95.50 | $128.82 | $245.47 |