- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.22 / $34.85 / $42.06
| Facility | 26 | $34.22 | $34.85 | $42.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.96 / $157.71 / $238.69
| Professional | | $140.96 | $157.71 | $238.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.65 / $161.00 / $161.00
| Professional | | $121.65 | $161.00 | $161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.95 / $178.88 / $278.95
| Professional | | $98.95 | $178.88 | $278.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.93 / $135.69 / $253.07
| Professional | | $85.93 | $135.69 | $253.07 |