- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.81 / $100.00 / $108.03
| Facility | 26 | $81.81 | $100.00 | $108.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $144.54
| Professional | 26 | $100.00 | $100.00 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.13 / $51.13 / $67.06
| Professional | 26 | $51.13 | $51.13 | $67.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.59 / $190.00 / $256.50
| Professional | 26 | $77.59 | $190.00 | $256.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.12 / $114.29 / $177.47
| Professional | 26 | $75.12 | $114.29 | $177.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.65 / $75.88 / $160.00
| Professional | 26 | $64.65 | $75.88 | $160.00 |