- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.97 / $87.97 / $87.97
| Facility | 26 | $87.97 | $87.97 | $87.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.90 / $120.35 / $162.47
| Professional | | $76.90 | $120.35 | $162.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.44 / $87.97 / $118.75
| Professional | 26 | $56.44 | $87.97 | $118.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.06 / $91.86 / $108.39
| Professional | | $67.06 | $91.86 | $108.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.79 / $66.84 / $78.87
| Professional | 26 | $48.79 | $66.84 | $78.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.42 / $130.59 / $293.08
| Professional | | $83.42 | $130.59 | $293.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.07 / $84.62 / $220.89
| Professional | 26 | $63.07 | $84.62 | $220.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.47 / $90.52 / $240.88
| Professional | | $68.47 | $90.52 | $240.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.66 / $66.17 / $84.12
| Professional | 26 | $49.66 | $66.17 | $84.12 |