- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $127.66 / $141.13 / $183.89
| Facility | 26 | $127.66 | $141.13 | $183.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.84 / $135.40 / $148.02
| Professional | 26 | $102.84 | $135.40 | $148.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $127.36 / $163.44 / $206.22
| Professional | 26 | $127.36 | $163.44 | $206.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.00 / $100.02 / $100.02
| Professional | 26 | $40.00 | $100.02 | $100.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.27 / $112.78 / $234.04
| Professional | 26 | $68.27 | $112.78 | $234.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $92.19 / $126.51 / $206.93
| Professional | 26 | $92.19 | $126.51 | $206.93 |