- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $143.00 / $396.49
| Facility | 26 | $100.00 | $143.00 | $396.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $175.51 / $404.00
| Professional | 26 | $100.00 | $175.51 | $404.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.99 / $139.74 / $178.16
| Professional | 26 | $85.99 | $139.74 | $178.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.05 / $127.36 / $202.05
| Professional | 26 | $95.05 | $127.36 | $202.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $196.71 / $196.71 / $196.71
| Professional | 26 | $196.71 | $196.71 | $196.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.86 / $155.01 / $274.37
| Professional | 26 | $112.86 | $155.01 | $274.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.86 / $167.99 / $291.72
| Professional | 26 | $112.86 | $167.99 | $291.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.25 / $132.41 / $395.11
| Professional | 26 | $93.25 | $132.41 | $395.11 |