- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $190.55 / $426.58
| Facility | 26 | $100.00 | $190.55 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.13 / $125.89 / $346.74
| Professional | 26 | $89.13 | $125.89 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $114.82 / $263.03
| Professional | 26 | $83.18 | $114.82 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.88 / $123.03 / $380.19
| Facility | 26 | $21.88 | $123.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $138.04 / $257.04
| Professional | 26 | $75.86 | $138.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $104.71 / $208.93
| Professional | 26 | $75.86 | $104.71 | $208.93 |