- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.97 / $217.58 / $481.46
| Facility | 26 | $93.97 | $217.58 | $481.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.19 / $107.89 / $297.67
| Professional | 26 | $87.19 | $107.89 | $297.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $177.44 / $177.44 / $177.44
| Professional | 26 | $177.44 | $177.44 | $177.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.58 / $146.46 / $289.23
| Professional | 26 | $102.58 | $146.46 | $289.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $110.69 / $190.72 / $296.45
| Professional | 26 | $110.69 | $190.72 | $296.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $116.64 / $185.95 / $212.08
| Professional | 26 | $116.64 | $185.95 | $212.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $105.24 / $140.22 / $269.72
| Professional | 26 | $105.24 | $140.22 | $269.72 |