- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $116.90 / $148.51 / $260.05
| Facility | 26 | $116.90 | $148.51 | $260.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $175.51 / $360.33
| Professional | 26 | $100.00 | $175.51 | $360.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.99 / $141.37 / $233.53
| Professional | 26 | $106.99 | $141.37 | $233.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $130.13 / $130.13 / $130.13
| Facility | 26 | $130.13 | $130.13 | $130.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $115.74 / $167.54 / $280.49
| Professional | 26 | $115.74 | $167.54 | $280.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $103.00 / $136.85 / $241.70
| Professional | 26 | $103.00 | $136.85 | $241.70 |