- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.53 / $327.57 / $327.57
| Facility | 26 | $125.53 | $327.57 | $327.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.69 / $142.49 / $442.27
| Professional | | $104.69 | $142.49 | $442.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.68 / $191.86 / $278.19
| Professional | | $130.68 | $191.86 | $278.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.87 / $286.27 / $405.24
| Professional | | $177.87 | $286.27 | $405.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.60 / $265.87 / $532.26
| Professional | | $149.60 | $265.87 | $532.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.85 / $187.82 / $458.57
| Professional | | $159.85 | $187.82 | $458.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.75 / $130.50 / $191.84
| Professional | | $108.75 | $130.50 | $191.84 |