- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $112.20 / $173.78 / $457.09
| Facility | 26 | $112.20 | $173.78 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.33 / $204.17 / $407.38
| Professional | 26 | $102.33 | $204.17 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $147.91 / $331.13
| Professional | 26 | $107.15 | $147.91 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $158.49 / $489.78
| Facility | 26 | $28.18 | $158.49 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $177.83 / $331.13
| Professional | 26 | $97.72 | $177.83 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.72 / $134.90 / $269.15
| Professional | 26 | $97.72 | $134.90 | $269.15 |