- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.00 / $125.00 / $125.00
| Facility | 26 | $125.00 | $125.00 | $125.00 |
- 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
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.10 / $111.83 / $178.99
| Professional | 26 | $91.10 | $111.83 | $178.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.58 / $143.52 / $193.70
| Professional | 26 | $112.58 | $143.52 | $193.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.76 / $123.52 / $231.75
| Professional | 26 | $106.76 | $123.52 | $231.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.00 / $134.80 / $265.00
| Professional | 26 | $90.00 | $134.80 | $265.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.50 / $131.81 / $174.30
| Professional | 26 | $91.50 | $131.81 | $174.30 |