- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.37 / $17.37 / $87.16
| Facility | 26 | $17.37 | $17.37 | $87.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.52 / $174.55 / $215.60
| Professional | | $128.52 | $174.55 | $215.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.87 / $211.55 / $369.93
| Professional | | $120.87 | $211.55 | $369.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.53 / $246.53 / $246.53
| Professional | | $246.53 | $246.53 | $246.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.41 / $192.25 / $254.24
| Professional | | $163.41 | $192.25 | $254.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.33 / $216.76 / $387.82
| Professional | | $132.33 | $216.76 | $387.82 |