- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $92.14 / $100.00 / $100.00
| Facility | 26 | $92.14 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $265.00
| Professional | 26 | $100.00 | $100.00 | $265.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.22 / $86.15 / $124.49
| Professional | 26 | $73.22 | $86.15 | $124.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $102.10 / $102.10 / $102.10
| Facility | 26 | $102.10 | $102.10 | $102.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.26 / $142.82 / $690.00
| Professional | 26 | $90.26 | $142.82 | $690.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $86.67 / $102.48 / $137.38
| Professional | 26 | $86.67 | $102.48 | $137.38 |