- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.55 / $106.17 / $145.97
| Facility | 26 | $95.55 | $106.17 | $145.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.55 / $105.02 / $167.21
| Professional | 26 | $95.55 | $105.02 | $167.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $108.85 / $128.06 / $176.69
| Professional | 26 | $108.85 | $128.06 | $176.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $124.44 / $124.44 / $124.44
| Facility | 26 | $124.44 | $124.44 | $124.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $115.82 / $169.88 / $270.02
| Professional | 26 | $115.82 | $169.88 | $270.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $105.06 / $135.49 / $169.37
| Professional | 26 | $105.06 | $135.49 | $169.37 |