- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $82.03 / $109.25 / $195.20
| Facility | 26 | $82.03 | $109.25 | $195.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.50 / $181.27 / $404.65
| Professional | | $133.50 | $181.27 | $404.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $99.98 / $99.98 / $99.98
| Facility | 26 | $99.98 | $99.98 | $99.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.87 / $216.26 / $350.61
| Professional | | $172.87 | $216.26 | $350.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.73 / $96.73 / $96.73
| Facility | 26 | $96.73 | $96.73 | $96.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.21 / $252.94 / $444.75
| Professional | | $161.21 | $252.94 | $444.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.09 / $217.87 / $393.94
| Professional | | $172.09 | $217.87 | $393.94 |