- 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
- $91.20 / $125.89 / $338.84
| Professional | 26 | $91.20 | $125.89 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.10 / $117.49 / $269.15
| Professional | 26 | $87.10 | $117.49 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.39 / $125.89 / $389.05
| Facility | 26 | $22.39 | $125.89 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $141.25 / $263.03
| Professional | 26 | $77.62 | $141.25 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $107.15 / $208.93
| Professional | 26 | $77.62 | $107.15 | $208.93 |