- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $142.69
| Facility | 26 | $100.00 | $100.00 | $142.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.44 / $96.22 / $136.63
| Professional | 26 | $84.44 | $96.22 | $136.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.27 / $128.35 / $229.00
| Professional | 26 | $107.27 | $128.35 | $229.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.89 / $103.31 / $182.01
| Professional | 26 | $83.89 | $103.31 | $182.01 |