- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $135.00 / $337.04 / $414.51
| Facility | 26 | $135.00 | $337.04 | $414.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.63 / $135.00 / $225.60
| Professional | 26 | $93.63 | $135.00 | $225.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.17 / $168.26 / $216.35
| Professional | 26 | $91.17 | $168.26 | $216.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.35 / $133.37 / $238.02
| Professional | 26 | $102.35 | $133.37 | $238.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.44 / $104.47 / $107.27
| Professional | 26 | $102.44 | $104.47 | $107.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.61 / $122.03 / $191.81
| Professional | 26 | $73.61 | $122.03 | $191.81 |