- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $98.05 / $539.08 / $908.66
| Facility | 26 | $98.05 | $539.08 | $908.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.00 / $98.05 / $600.96
| Professional | 26 | $87.00 | $98.05 | $600.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $178.34 / $190.62 / $195.38
| Professional | 26 | $178.34 | $190.62 | $195.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $562.50 / $562.50 / $562.50
| Facility | 26 | $562.50 | $562.50 | $562.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $193.13 / $229.61 / $287.01
| Professional | 26 | $193.13 | $229.61 | $287.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $945.52 / $945.52 / $945.52
| Facility | 26 | $945.52 | $945.52 | $945.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $124.70 / $202.64 / $305.76
| Professional | 26 | $124.70 | $202.64 | $305.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $340.20 / $350.11 / $562.50
| Facility | 26 | $340.20 | $350.11 | $562.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $124.70 / $197.17 / $259.80
| Professional | 26 | $124.70 | $197.17 | $259.80 |