- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $151.36 / $269.15 / $316.23
| Facility | 26 | $151.36 | $269.15 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $151.36 / $426.58
| Professional | 26 | $95.50 | $151.36 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $107.15 / $190.55
| Professional | 26 | $70.79 | $107.15 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $97.72 / $177.83
| Professional | 26 | $85.11 | $97.72 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $77.62 / $91.20
| Professional | 26 | $75.86 | $77.62 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.95 / $89.13 / $141.25
| Professional | 26 | $54.95 | $89.13 | $141.25 |