- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $136.57 / $169.18 / $180.00
| Facility | 26 | $136.57 | $169.18 | $180.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $118.75 / $180.00 / $291.50
| Professional | 26 | $118.75 | $180.00 | $291.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $116.91 / $134.11 / $171.93
| Professional | 26 | $116.91 | $134.11 | $171.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.45 / $151.94 / $170.31
| Professional | 26 | $100.45 | $151.94 | $170.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.90 / $118.34 / $195.06
| Professional | 26 | $87.90 | $118.34 | $195.06 |