- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.73 / $137.60 / $151.36
| Professional | | $124.73 | $137.60 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.06 / $24.31 / $25.62
| Professional | 26 | $23.06 | $24.31 | $25.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.73 / $182.44 / $273.95
| Professional | | $127.73 | $182.44 | $273.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.68 / $28.24 / $42.53
| Professional | 26 | $19.68 | $28.24 | $42.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.61 / $195.98 / $353.67
| Professional | | $128.61 | $195.98 | $353.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.72 / $28.64 / $56.98
| Professional | 26 | $20.72 | $28.64 | $56.98 |