- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.90 / $40.90 / $93.51
| Facility | 26 | $40.90 | $40.90 | $93.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.48 / $117.25 / $147.62
| Professional | | $85.48 | $117.25 | $147.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.60 / $256.82 / $282.11
| Professional | | $213.60 | $256.82 | $282.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.98 / $199.36 / $233.52
| Professional | | $167.98 | $199.36 | $233.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.72 / $228.03 / $306.08
| Professional | | $145.72 | $228.03 | $306.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.58 / $266.55 / $308.38
| Professional | | $133.58 | $266.55 | $308.38 |