- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.48 / $97.78 / $591.47
| Facility | 26 | $93.48 | $97.78 | $591.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.18 / $97.78 / $145.27
| Professional | 26 | $89.18 | $97.78 | $145.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.59 / $80.59 / $206.50
| Professional | 26 | $80.59 | $80.59 | $206.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.90 / $159.36 / $235.20
| Professional | 26 | $95.90 | $159.36 | $235.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.19 / $135.19 / $135.19
| Facility | 26 | $135.19 | $135.19 | $135.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.76 / $163.27 / $252.81
| Professional | 26 | $95.76 | $163.27 | $252.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $259.18 / $529.63 / $529.63
| Facility | 26 | $259.18 | $529.63 | $529.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $680.84 / $680.84 / $882.38
| Professional | 26 | $680.84 | $680.84 | $882.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $108.75 / $134.72 / $279.76
| Professional | 26 | $108.75 | $134.72 | $279.76 |