- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $120.23 / $147.91 / $186.21
| Facility | 26 | $120.23 | $147.91 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $169.82 / $323.59
| Professional | 26 | $100.00 | $169.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $107.15 / $162.18
| Professional | 26 | $85.11 | $107.15 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $120.23 / $199.53
| Professional | 26 | $107.15 | $120.23 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $134.90 / $154.88 / $275.42
| Professional | 26 | $134.90 | $154.88 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $128.82 / $223.87
| Professional | 26 | $107.15 | $128.82 | $223.87 |