- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.17 / $55.09 / $123.31
| Facility | 26 | $24.17 | $55.09 | $123.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.41 / $117.46 / $274.77
| Professional | | $100.41 | $117.46 | $274.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.55 / $146.01 / $303.83
| Professional | | $95.55 | $146.01 | $303.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.07 / $31.07 / $31.07
| Facility | 26 | $31.07 | $31.07 | $31.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.41 / $168.41 / $318.41
| Professional | | $98.41 | $168.41 | $318.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.56 / $211.33 / $443.12
| Professional | | $132.56 | $211.33 | $443.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.93 / $46.12 / $99.64
| Professional | 26 | $28.93 | $46.12 | $99.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.54 / $135.66 / $222.94
| Professional | | $37.54 | $135.66 | $222.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.98 / $146.97 / $266.02
| Professional | | $104.98 | $146.97 | $266.02 |