- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.36 / $69.42 / $173.10
| Facility | 26 | $24.36 | $69.42 | $173.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.26 / $131.99 / $131.99
| Professional | | $110.26 | $131.99 | $131.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.81 / $144.22 / $259.04
| Professional | | $129.81 | $144.22 | $259.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.39 / $147.19 / $575.01
| Professional | | $98.39 | $147.19 | $575.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.66 / $321.64 / $321.64
| Professional | | $141.66 | $321.64 | $321.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.40 / $59.54 / $59.54
| Professional | 26 | $27.40 | $59.54 | $59.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.23 / $184.32 / $407.58
| Professional | | $87.23 | $184.32 | $407.58 |