- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $136.01 / $371.89 / $371.89
| Facility | 26 | $136.01 | $371.89 | $371.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $125.00 / $125.00 / $125.00
| Professional | 26 | $125.00 | $125.00 | $125.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.34 / $186.60 / $270.57
| Professional | 26 | $87.34 | $186.60 | $270.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $114.08 / $203.83 / $269.79
| Professional | 26 | $114.08 | $203.83 | $269.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $101.49 / $177.30 / $329.34
| Professional | 26 | $101.49 | $177.30 | $329.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.31 / $115.34 / $181.75
| Professional | 26 | $83.31 | $115.34 | $181.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.83 / $78.47 / $85.61
| Professional | 26 | $70.83 | $78.47 | $85.61 |