- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.42 / $465.99 / $903.90
| Facility | 26 | $96.42 | $465.99 | $903.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.38 / $96.42 / $259.45
| Professional | 26 | $93.38 | $96.42 | $259.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $125.52 / $128.12 / $166.94
| Professional | 26 | $125.52 | $128.12 | $166.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.00 / $186.81 / $475.96
| Professional | 26 | $98.00 | $186.81 | $475.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.34 / $236.75 / $236.75
| Professional | 26 | $109.34 | $236.75 | $236.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.78 / $153.72 / $354.15
| Professional | 26 | $91.78 | $153.72 | $354.15 |