- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.23 / $355.93 / $599.95
| Facility | 26 | $66.23 | $355.93 | $599.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.23 / $160.80 / $406.19
| Professional | 26 | $66.23 | $160.80 | $406.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $121.39 / $129.75 / $133.00
| Professional | 26 | $121.39 | $129.75 | $133.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $382.98 / $382.98 / $382.98
| Facility | 26 | $382.98 | $382.98 | $382.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $131.49 / $156.69 / $195.86
| Professional | 26 | $131.49 | $156.69 | $195.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $642.55 / $642.55 / $642.55
| Facility | 26 | $642.55 | $642.55 | $642.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.46 / $137.24 / $203.28
| Professional | 26 | $84.46 | $137.24 | $203.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $224.26 / $230.79 / $382.98
| Facility | 26 | $224.26 | $230.79 | $382.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.46 / $135.62 / $175.95
| Professional | 26 | $84.46 | $135.62 | $175.95 |