- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $112.34 / $123.57 / $138.68
| Facility | 26 | $112.34 | $123.57 | $138.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.00 / $125.00 / $265.00
| Professional | 26 | $90.00 | $125.00 | $265.00 |
- 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
- $119.62 / $149.36 / $690.00
| Professional | 26 | $119.62 | $149.36 | $690.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $243.18 / $295.12 / $303.91
| Professional | 26 | $243.18 | $295.12 | $303.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.06 / $112.19 / $208.11
| Professional | 26 | $74.06 | $112.19 | $208.11 |