- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $126.14 / $145.28 / $247.20
| Facility | 26 | $126.14 | $145.28 | $247.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.67 / $105.12 / $129.41
| Professional | 26 | $72.67 | $105.12 | $129.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $116.08 / $116.08 / $116.08
| Professional | 26 | $116.08 | $116.08 | $116.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $99.33 / $154.97 / $203.07
| Professional | 26 | $99.33 | $154.97 | $203.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $259.18 / $259.18 / $259.18
| Facility | 26 | $259.18 | $259.18 | $259.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.44 / $150.52 / $680.84
| Professional | 26 | $109.44 | $150.52 | $680.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.44 / $131.84 / $224.03
| Professional | 26 | $109.44 | $131.84 | $224.03 |