- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $99.20 / $100.00 / $130.97
| Facility | 26 | $99.20 | $100.00 | $130.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $265.00
| Professional | 26 | $100.00 | $100.00 | $265.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.05 / $138.19 / $186.57
| Professional | 26 | $79.05 | $138.19 | $186.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $103.01 / $120.30 / $227.87
| Professional | 26 | $103.01 | $120.30 | $227.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.33 / $102.70 / $189.49
| Professional | 26 | $78.33 | $102.70 | $189.49 |