- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $105.02 / $191.75 / $378.28
| Facility | 26 | $105.02 | $191.75 | $378.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.84 / $105.02 / $222.64
| Professional | 26 | $102.84 | $105.02 | $222.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.88 / $82.88 / $145.05
| Professional | 26 | $82.88 | $82.88 | $145.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $121.63 / $145.11 / $222.18
| Professional | 26 | $121.63 | $145.11 | $222.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.19 / $135.19 / $135.19
| Facility | 26 | $135.19 | $135.19 | $135.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $103.59 / $147.21 / $254.11
| Professional | 26 | $103.59 | $147.21 | $254.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.19 / $135.19 / $135.19
| Facility | 26 | $135.19 | $135.19 | $135.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.14 / $161.51 / $286.08
| Professional | 26 | $109.14 | $161.51 | $286.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.45 / $133.93 / $224.72
| Professional | 26 | $95.45 | $133.93 | $224.72 |