- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.72 / $124.53 / $204.90
| Facility | 26 | $81.72 | $124.53 | $204.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.72 / $100.00 / $125.00
| Professional | 26 | $81.72 | $100.00 | $125.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.53 / $103.82 / $168.00
| Professional | 26 | $81.53 | $103.82 | $168.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $658.80 / $658.80 / $658.80
| Facility | 26 | $658.80 | $658.80 | $658.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.63 / $107.86 / $1,463.88
| Professional | 26 | $83.63 | $107.86 | $1,463.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.63 / $94.38 / $192.25
| Professional | 26 | $83.63 | $94.38 | $192.25 |