- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $117.49 / $125.89
| Facility | 26 | $70.79 | $117.49 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $125.89 / $239.88
| Professional | 26 | $70.79 | $125.89 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.49 / $154.88 / $173.78
| Professional | 26 | $117.49 | $154.88 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $128.82 / $162.18
| Professional | 26 | $85.11 | $128.82 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $134.90 / $3,235.94
| Professional | 26 | $69.18 | $134.90 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $134.90 / $186.21
| Professional | 26 | $69.18 | $134.90 | $186.21 |