- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $130.02 / $245.07
| Facility | 26 | $100.00 | $130.02 | $245.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.00 / $125.00 / $267.14
| Professional | 26 | $90.00 | $125.00 | $267.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.74 / $115.54 / $189.57
| Professional | 26 | $80.74 | $115.54 | $189.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.81 / $95.81 / $95.81
| Facility | 26 | $95.81 | $95.81 | $95.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.45 / $124.03 / $210.19
| Professional | 26 | $87.45 | $124.03 | $210.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.23 / $106.54 / $180.00
| Professional | 26 | $77.23 | $106.54 | $180.00 |