- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $80.73 / $445.72 / $751.30
| Facility | 26 | $80.73 | $445.72 | $751.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.73 / $87.00 / $492.43
| Professional | 26 | $80.73 | $87.00 | $492.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $148.66 / $158.90 / $162.87
| Professional | 26 | $148.66 | $158.90 | $162.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $468.90 / $468.90 / $468.90
| Facility | 26 | $468.90 | $468.90 | $468.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $160.99 / $190.82 / $238.53
| Professional | 26 | $160.99 | $190.82 | $238.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $1,566.00 / $1,566.00 / $1,566.00
| Facility | 26 | $1,566.00 | $1,566.00 | $1,566.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $105.75 / $166.22 / $253.77
| Professional | 26 | $105.75 | $166.22 | $253.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $291.50 / $299.99 / $468.90
| Facility | 26 | $291.50 | $299.99 | $468.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $105.75 / $164.26 / $213.10
| Professional | 26 | $105.75 | $164.26 | $213.10 |