- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $98.71 / $133.41 / $150.77
| Facility | 26 | $98.71 | $133.41 | $150.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.56 / $104.39 / $135.00
| Professional | 26 | $30.56 | $104.39 | $135.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.02 / $77.48 / $90.42
| Professional | 26 | $29.02 | $77.48 | $90.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.09 / $42.08 / $75.12
| Professional | 26 | $37.09 | $42.08 | $75.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.61 / $32.61 / $32.61
| Professional | 26 | $32.61 | $32.61 | $32.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.96 / $43.74 / $64.14
| Professional | 26 | $24.96 | $43.74 | $64.14 |