- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $114.82 / $125.89 / $194.98
| Facility | 26 | $114.82 | $125.89 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.65 / $245.47 / $407.38
| Professional | 26 | $109.65 | $245.47 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $199.53 / $257.04 / $288.40
| Professional | 26 | $199.53 | $257.04 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $141.25 / $213.80 / $275.42
| Professional | 26 | $141.25 | $213.80 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.49 / $229.09 / $1,202.26
| Professional | 26 | $117.49 | $229.09 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.49 / $223.87 / $309.03
| Professional | 26 | $117.49 | $223.87 | $309.03 |