- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.15 / $34.15 / $34.15
| Facility | 26 | $34.15 | $34.15 | $34.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.74 / $148.69 / $193.99
| Professional | | $122.74 | $148.69 | $193.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.80 / $140.94 / $206.58
| Professional | | $119.80 | $140.94 | $206.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.06 / $159.61 / $297.52
| Professional | | $81.06 | $159.61 | $297.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.56 / $148.86 / $226.83
| Professional | | $70.56 | $148.86 | $226.83 |