- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $151.36 / $457.09 / $537.03
| Facility | 26 | $151.36 | $457.09 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $114.82 / $199.53 / $501.19
| Professional | 26 | $114.82 | $199.53 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $120.23 / $186.21 / $323.59
| Professional | 26 | $120.23 | $186.21 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.49 / $165.96 / $302.00
| Professional | 26 | $117.49 | $165.96 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $128.82 / $128.82 / $154.88
| Professional | 26 | $128.82 | $128.82 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.33 / $147.91 / $234.42
| Professional | 26 | $93.33 | $147.91 | $234.42 |