- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.27 / $303.04 / $378.78
| Facility | 26 | $125.27 | $303.04 | $378.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.63 / $155.00 / $528.29
| Professional | 26 | $93.63 | $155.00 | $528.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.67 / $90.23 / $437.06
| Professional | 26 | $67.67 | $90.23 | $437.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.00 / $121.04 / $189.21
| Professional | 26 | $63.00 | $121.04 | $189.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $658.80 / $853.92 / $853.92
| Facility | 26 | $658.80 | $853.92 | $853.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.98 / $89.33 / $1,463.88
| Professional | 26 | $80.98 | $89.33 | $1,463.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.98 / $86.91 / $186.00
| Professional | 26 | $80.98 | $86.91 | $186.00 |