- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.89 / $213.80 / $446.68
| Facility | 26 | $125.89 | $213.80 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.65 / $154.88 / $354.81
| Professional | 26 | $109.65 | $154.88 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $141.25 / $169.82 / $363.08
| Professional | 26 | $141.25 | $169.82 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.65 / $234.42 / $338.84
| Professional | 26 | $109.65 | $234.42 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $141.25 / $257.04 / $331.13
| Professional | 26 | $141.25 | $257.04 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $123.03 / $208.93 / $338.84
| Professional | 26 | $123.03 | $208.93 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.49 / $147.91 / $302.00
| Professional | 26 | $117.49 | $147.91 | $302.00 |