- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $128.00 / $128.00 / $128.00
| Facility | 26 | $128.00 | $128.00 | $128.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.53 / $475.00 / $522.50
| Professional | | $188.53 | $475.00 | $522.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.52 / $306.77 / $622.46
| Professional | | $206.52 | $306.77 | $622.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.98 / $117.87 / $194.07
| Professional | | $52.98 | $117.87 | $194.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $418.84 / $418.84 / $418.84
| Facility | 26 | $418.84 | $418.84 | $418.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.19 / $379.50 / $505.88
| Professional | | $325.19 | $379.50 | $505.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.67 / $401.68 / $719.57
| Professional | | $211.67 | $401.68 | $719.57 |