- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $281.62 / $281.62 / $281.62
| Facility | 26 | $281.62 | $281.62 | $281.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.84 / $121.41 / $230.16
| Professional | 26 | $102.84 | $121.41 | $230.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $134.44 / $181.47 / $208.03
| Professional | 26 | $134.44 | $181.47 | $208.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $173.99 / $184.54 / $210.90
| Professional | 26 | $173.99 | $184.54 | $210.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $484.26 / $484.26 / $484.26
| Facility | 26 | $484.26 | $484.26 | $484.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $205.74 / $219.89 / $265.75
| Professional | 26 | $205.74 | $219.89 | $265.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.95 / $123.12 / $220.32
| Professional | 26 | $98.95 | $123.12 | $220.32 |