- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $151.00 / $304.94
| Facility | 26 | $100.00 | $151.00 | $304.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $106.00 / $265.00
| Professional | 26 | $100.00 | $106.00 | $265.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.29 / $99.39 / $157.68
| Professional | 26 | $74.29 | $99.39 | $157.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.57 / $121.74 / $213.46
| Professional | 26 | $87.57 | $121.74 | $213.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.57 / $121.40 / $213.46
| Professional | 26 | $87.57 | $121.40 | $213.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.22 / $97.73 / $193.12
| Professional | 26 | $73.22 | $97.73 | $193.12 |