- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $115.58 / $146.13 / $270.00
| Facility | 26 | $115.58 | $146.13 | $270.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $167.31 / $364.49
| Professional | 26 | $100.00 | $167.31 | $364.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.04 / $139.72 / $231.33
| Professional | 26 | $106.04 | $139.72 | $231.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $128.81 / $128.81 / $128.81
| Facility | 26 | $128.81 | $128.81 | $128.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.82 / $166.61 / $278.31
| Professional | 26 | $112.82 | $166.61 | $278.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $101.76 / $136.54 / $243.92
| Professional | 26 | $101.76 | $136.54 | $243.92 |