- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.75 / $68.30 / $153.19
| Facility | 26 | $37.75 | $68.30 | $153.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.91 / $150.72 / $251.81
| Professional | | $108.91 | $150.72 | $251.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.24 / $209.73 / $299.51
| Professional | | $116.24 | $209.73 | $299.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.35 / $213.41 / $461.14
| Professional | | $82.35 | $213.41 | $461.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.81 / $197.90 / $281.60
| Professional | | $164.81 | $197.90 | $281.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.98 / $42.98 / $42.98
| Professional | | $42.98 | $42.98 | $42.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.27 / $209.04 / $465.68
| Professional | | $114.27 | $209.04 | $465.68 |