- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $151.12 / $365.58 / $456.95
| Facility | 26 | $151.12 | $365.58 | $456.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.50 / $113.50 / $551.00
| Professional | 26 | $97.50 | $113.50 | $551.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $145.78 / $145.78 / $145.78
| Professional | 26 | $145.78 | $145.78 | $145.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.14 / $97.58 / $194.56
| Professional | 26 | $95.14 | $97.58 | $194.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.99 / $144.33 / $231.99
| Professional | 26 | $91.99 | $144.33 | $231.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $259.18 / $505.23 / $505.23
| Facility | 26 | $259.18 | $505.23 | $505.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.25 / $108.41 / $680.84
| Professional | 26 | $98.25 | $108.41 | $680.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.25 / $102.39 / $219.61
| Professional | 26 | $98.25 | $102.39 | $219.61 |