- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $105.48 / $139.83 / $256.72
| Facility | 26 | $105.48 | $139.83 | $256.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $94.62 / $105.12 / $222.64
| Professional | 26 | $94.62 | $105.12 | $222.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.34 / $146.16 / $223.28
| Professional | 26 | $106.34 | $146.16 | $223.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.19 / $135.19 / $135.19
| Facility | 26 | $135.19 | $135.19 | $135.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $110.69 / $158.69 / $264.11
| Professional | 26 | $110.69 | $158.69 | $264.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $101.73 / $134.72 / $234.40
| Professional | 26 | $101.73 | $134.72 | $234.40 |