- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $151.36 / $354.81 / $416.87
| Facility | 26 | $151.36 | $354.81 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.49 / $134.90 / $331.13
| Professional | 26 | $117.49 | $134.90 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $154.88 / $257.04
| Professional | 26 | $95.50 | $154.88 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $134.90 / $239.88
| Professional | 26 | $95.50 | $134.90 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.33 / $104.71 / $125.89
| Professional | 26 | $102.33 | $104.71 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $117.49 / $186.21
| Professional | 26 | $74.13 | $117.49 | $186.21 |