- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.80 / $107.62 / $622.90
| Facility | 26 | $87.80 | $107.62 | $622.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.36 / $104.21 / $109.12
| Professional | 26 | $73.36 | $104.21 | $109.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $96.39 / $111.31 / $171.40
| Professional | 26 | $96.39 | $111.31 | $171.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $259.18 / $505.23 / $505.23
| Facility | 26 | $259.18 | $505.23 | $505.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.25 / $117.49 / $680.84
| Professional | 26 | $98.25 | $117.49 | $680.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.25 / $117.01 / $199.66
| Professional | 26 | $98.25 | $117.01 | $199.66 |