- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $125.89 / $436.52
| Facility | 26 | $70.79 | $125.89 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $117.49 / $234.42
| Professional | 26 | $67.61 | $117.49 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $67.61 / $67.61
| Professional | 26 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $69.18 / $117.49
| Professional | 26 | $60.26 | $69.18 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $501.19 / $645.65 / $645.65
| Facility | 26 | $501.19 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $66.07 / $3,235.94
| Professional | 26 | $51.29 | $66.07 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $61.66 / $87.10
| Professional | 26 | $51.29 | $61.66 | $87.10 |