- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.39 / $48.39 / $88.52
| Facility | 26 | $48.39 | $48.39 | $88.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.43 / $212.94 / $238.72
| Professional | | $198.43 | $212.94 | $238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.00 / $66.00 / $127.38
| Professional | | $66.00 | $66.00 | $127.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.35 / $205.87 / $314.86
| Professional | | $57.35 | $205.87 | $314.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.88 / $133.51 / $376.00
| Professional | | $67.88 | $133.51 | $376.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.07 / $175.42 / $403.64
| Professional | | $135.07 | $175.42 | $403.64 |