- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $180.45
| Facility | 26 | $100.00 | $100.00 | $180.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.44 / $100.00 / $265.00
| Professional | 26 | $38.44 | $100.00 | $265.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.79 / $28.94 / $38.11
| Professional | 26 | $21.79 | $28.94 | $38.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.92 / $32.64 / $53.22
| Professional | 26 | $24.92 | $32.64 | $53.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.60 / $39.50 / $66.62
| Professional | 26 | $28.60 | $39.50 | $66.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.22 / $39.50 / $65.12
| Professional | 26 | $29.22 | $39.50 | $65.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.56 / $32.65 / $60.82
| Professional | 26 | $23.56 | $32.65 | $60.82 |