- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.21 / $44.44 / $81.96
| Facility | 26 | $36.21 | $44.44 | $81.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.98 / $100.67 / $148.69
| Professional | | $81.98 | $100.67 | $148.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.67 / $118.98 / $194.31
| Professional | | $93.67 | $118.98 | $194.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.40 / $43.40 / $43.40
| Facility | 26 | $43.40 | $43.40 | $43.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.97 / $134.51 / $220.73
| Professional | | $86.97 | $134.51 | $220.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.62 / $110.59 / $190.37
| Professional | | $90.62 | $110.59 | $190.37 |