- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $61.71 / $78.37 / $78.37
| Facility | 26 | $61.71 | $78.37 | $78.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.71 / $216.05 / $236.95
| Professional | | $189.71 | $216.05 | $236.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.83 / $61.71 / $66.63
| Professional | 26 | $53.83 | $61.71 | $66.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.47 / $377.98 / $518.29
| Professional | | $203.47 | $377.98 | $518.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.61 / $65.34 / $109.50
| Professional | 26 | $43.61 | $65.34 | $109.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.38 / $345.88 / $524.61
| Professional | | $187.38 | $345.88 | $524.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.73 / $71.45 / $141.97
| Professional | 26 | $48.73 | $71.45 | $141.97 |