- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $26.92 / $26.92
| Facility | 26 | $26.92 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $194.98 / $275.42
| Professional | | $123.03 | $194.98 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $223.87 / $354.81
| Professional | | $177.83 | $223.87 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.26 / $331.13
| Professional | | $32.36 | $60.26 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $691.83 / $691.83 / $691.83
| Facility | 26 | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $380.19 / $407.38
| Professional | | $269.15 | $380.19 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $275.42 / $467.74
| Professional | | $186.21 | $275.42 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $223.87 / $331.13
| Professional | | $31.62 | $223.87 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $208.93 / $338.84
| Professional | | $162.18 | $208.93 | $338.84 |