- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $104.71 / $162.18 / $436.52
| Facility | 26 | $104.71 | $162.18 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $177.83 / $407.38
| Professional | 26 | $100.00 | $177.83 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $147.91 / $331.13
| Professional | 26 | $107.15 | $147.91 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.54 / $158.49 / $478.63
| Facility | 26 | $27.54 | $158.49 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $173.78 / $331.13
| Professional | 26 | $95.50 | $173.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.50 / $131.83 / $263.03
| Professional | 26 | $95.50 | $131.83 | $263.03 |