- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.87 / $133.11 / $623.00
| Professional | | $113.87 | $133.11 | $623.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $336.37 / $336.37 / $336.37
| Facility | 26 | $336.37 | $336.37 | $336.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.69 / $179.99 / $500.37
| Professional | | $152.69 | $179.99 | $500.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.33 / $174.39 / $500.37
| Professional | | $158.33 | $174.39 | $500.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.63 / $167.44 / $500.37
| Professional | | $140.63 | $167.44 | $500.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.43 / $158.47 / $273.27
| Professional | | $123.43 | $158.47 | $273.27 |