- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $142.07 / $343.68 / $429.58
| Facility | 26 | $142.07 | $343.68 | $429.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.00 / $155.69 / $291.50
| Professional | 26 | $90.00 | $155.69 | $291.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.41 / $100.54 / $487.01
| Professional | 26 | $75.41 | $100.54 | $487.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.89 / $134.30 / $215.95
| Professional | 26 | $70.89 | $134.30 | $215.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $734.80 / $945.52 / $945.52
| Facility | 26 | $734.80 | $945.52 | $945.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.98 / $100.33 / $1,192.32
| Professional | 26 | $90.98 | $100.33 | $1,192.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.98 / $95.15 / $232.55
| Professional | 26 | $90.98 | $95.15 | $232.55 |