- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $151.00 / $315.41
| Facility | 26 | $100.00 | $151.00 | $315.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $103.49 / $265.00
| Professional | 26 | $100.00 | $103.49 | $265.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.84 / $102.59 / $162.75
| Professional | 26 | $76.84 | $102.59 | $162.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.99 / $124.00 / $221.37
| Professional | 26 | $87.99 | $124.00 | $221.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.99 / $122.02 / $221.37
| Professional | 26 | $87.99 | $122.02 | $221.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.94 / $102.25 / $184.95
| Professional | 26 | $74.94 | $102.25 | $184.95 |