- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $177.40
| Facility | 26 | $100.00 | $100.00 | $177.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $174.30 / $329.94
| Professional | 26 | $100.00 | $174.30 | $329.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.19 / $157.32 / $229.77
| Professional | 26 | $117.19 | $157.32 | $229.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $110.08 / $150.13 / $268.06
| Professional | 26 | $110.08 | $150.13 | $268.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $110.36 / $182.09 / $414.17
| Professional | 26 | $110.36 | $182.09 | $414.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $103.47 / $190.85 / $417.25
| Professional | 26 | $103.47 | $190.85 | $417.25 |