- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $178.51
| Facility | 26 | $100.00 | $100.00 | $178.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $230.40 / $362.78
| Professional | 26 | $100.00 | $230.40 | $362.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $117.88 / $158.25 / $231.12
| Professional | 26 | $117.88 | $158.25 | $231.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $111.02 / $151.25 / $274.37
| Professional | 26 | $111.02 | $151.25 | $274.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $111.10 / $183.32 / $418.00
| Professional | 26 | $111.10 | $183.32 | $418.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.93 / $196.32 / $306.75
| Professional | 26 | $102.93 | $196.32 | $306.75 |