- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $86.11 / $466.38 / $786.12
| Facility | 26 | $86.11 | $466.38 | $786.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $86.11 / $86.11 / $524.91
| Professional | 26 | $86.11 | $86.11 | $524.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $157.31 / $168.16 / $172.36
| Professional | 26 | $157.31 | $168.16 | $172.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $496.26 / $496.26 / $496.26
| Facility | 26 | $496.26 | $496.26 | $496.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $170.38 / $202.46 / $253.07
| Professional | 26 | $170.38 | $202.46 | $253.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $834.64 / $834.64 / $834.64
| Facility | 26 | $834.64 | $834.64 | $834.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $108.95 / $177.04 / $265.16
| Professional | 26 | $108.95 | $177.04 | $265.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $297.44 / $306.11 / $496.26
| Facility | 26 | $297.44 | $306.11 | $496.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $108.95 / $174.95 / $226.98
| Professional | 26 | $108.95 | $174.95 | $226.98 |