- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $93.33 / $177.83
| Professional | | $58.88 | $93.33 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | 26 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $123.03 / $407.38
| Professional | | $102.33 | $123.03 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $123.03 / $288.40
| Professional | | $100.00 | $123.03 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $407.38
| Professional | | $79.43 | $79.43 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $109.65 / $323.59
| Professional | | $91.20 | $109.65 | $323.59 |