- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $114.89 / $114.89 / $185.31
| Facility | 26 | $114.89 | $114.89 | $185.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.48 / $110.26 / $114.89
| Professional | 26 | $93.48 | $110.26 | $114.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $209.74 / $225.21 / $266.08
| Professional | 26 | $209.74 | $225.21 | $266.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $131.63 / $201.10 / $266.70
| Professional | 26 | $131.63 | $201.10 | $266.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.59 / $219.94 / $680.84
| Professional | 26 | $112.59 | $219.94 | $680.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $116.93 / $208.37 / $286.27
| Professional | 26 | $116.93 | $208.37 | $286.27 |