- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.74 / $29.85 / $35.82
| Facility | 26 | $26.74 | $29.85 | $35.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.52 / $227.68 / $227.68
| Professional | | $128.52 | $227.68 | $227.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.43 / $210.41 / $269.75
| Professional | | $183.43 | $210.41 | $269.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.19 / $220.14 / $330.65
| Professional | | $139.19 | $220.14 | $330.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.47 / $180.13 / $316.70
| Professional | | $117.47 | $180.13 | $316.70 |