- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.33 / $132.35 / $169.56
| Facility | 26 | $37.33 | $132.35 | $169.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.40 / $115.04 / $163.65
| Professional | | $82.40 | $115.04 | $163.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.54 / $179.89 / $343.59
| Professional | | $95.54 | $179.89 | $343.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.36 / $143.22 / $240.56
| Professional | | $109.36 | $143.22 | $240.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.20 / $132.77 / $181.98
| Professional | | $106.20 | $132.77 | $181.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.50 / $56.97 / $111.14
| Professional | | $55.50 | $56.97 | $111.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.39 / $120.24 / $190.37
| Professional | | $86.39 | $120.24 | $190.37 |