- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.02 / $114.57 / $139.72
| Professional | | $111.02 | $114.57 | $139.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $160.16 / $160.16 / $160.16
| Facility | 26 | $160.16 | $160.16 | $160.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.29 / $171.00 / $580.11
| Professional | | $139.29 | $171.00 | $580.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.36 / $191.64 / $580.11
| Professional | | $138.36 | $191.64 | $580.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.69 / $163.03 / $580.11
| Professional | | $130.69 | $163.03 | $580.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.06 / $157.27 / $617.09
| Professional | | $122.06 | $157.27 | $617.09 |