- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.62 / $52.55 / $58.84
| Facility | 26 | $44.62 | $52.55 | $58.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.55 / $130.63 / $161.82
| Professional | | $81.55 | $130.63 | $161.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.85 / $84.85 / $84.85
| Professional | | $84.85 | $84.85 | $84.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.79 / $150.61 / $167.34
| Professional | | $113.79 | $150.61 | $167.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.61 / $78.33 / $140.90
| Professional | | $33.61 | $78.33 | $140.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.82 / $146.61 / $214.00
| Professional | | $93.82 | $146.61 | $214.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.05 / $123.46 / $203.21
| Professional | | $102.05 | $123.46 | $203.21 |