- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $179.14
| Facility | 26 | $100.00 | $100.00 | $179.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $265.00
| Professional | 26 | $100.00 | $100.00 | $265.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.00 / $145.41 / $159.00
| Professional | 26 | $106.00 | $145.41 | $159.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.00 / $119.02 / $169.00
| Professional | 26 | $106.00 | $119.02 | $169.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $133.46 / $159.78 / $284.69
| Professional | 26 | $133.46 | $159.78 | $284.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.75 / $129.91 / $225.30
| Professional | 26 | $106.75 | $129.91 | $225.30 |