- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.00 / $334.26 / $922.56
| Facility | 26 | $125.00 | $334.26 | $922.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $125.00 / $125.00 / $263.55
| Professional | 26 | $125.00 | $125.00 | $263.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $121.08 / $127.39 / $139.32
| Professional | 26 | $121.08 | $127.39 | $139.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.35 / $189.76 / $545.39
| Professional | 26 | $95.35 | $189.76 | $545.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $113.23 / $246.12 / $246.12
| Professional | 26 | $113.23 | $246.12 | $246.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $86.40 / $127.78 / $366.72
| Professional | 26 | $86.40 | $127.78 | $366.72 |