- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $123.57 / $390.36 / $509.28
| Facility | 26 | $123.57 | $390.36 | $509.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $86.45 / $123.57 / $368.23
| Professional | 26 | $86.45 | $123.57 | $368.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.34 / $163.16 / $190.07
| Professional | 26 | $106.34 | $163.16 | $190.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $140.35 / $157.99 / $255.33
| Professional | 26 | $140.35 | $157.99 | $255.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $110.63 / $115.01 / $124.09
| Professional | 26 | $110.63 | $115.01 | $124.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.24 / $179.17 / $319.27
| Professional | 26 | $98.24 | $179.17 | $319.27 |