- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $151.40 / $370.55 / $370.55
| Facility | 26 | $151.40 | $370.55 | $370.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.44 / $186.29 / $307.63
| Professional | | $158.44 | $186.29 | $307.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.98 / $369.95 / $518.70
| Professional | | $251.98 | $369.95 | $518.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.20 / $450.25 / $777.68
| Professional | | $282.20 | $450.25 | $777.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.45 / $480.29 / $890.33
| Professional | | $288.45 | $480.29 | $890.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.09 / $311.95 / $520.73
| Professional | | $210.09 | $311.95 | $520.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.47 / $217.22 / $276.45
| Professional | | $197.47 | $217.22 | $276.45 |