- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.55 / $216.27 / $939.10
| Professional | | $103.55 | $216.27 | $939.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $88.98 / $386.06
| Professional | 26 | $41.69 | $88.98 | $386.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.16 / $238.05 / $286.04
| Professional | | $157.16 | $238.05 | $286.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.23 / $94.47 / $119.75
| Professional | 26 | $64.23 | $94.47 | $119.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.56 / $190.58 / $286.04
| Professional | | $117.56 | $190.58 | $286.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.01 / $80.06 / $119.75
| Professional | 26 | $49.01 | $80.06 | $119.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.81 / $138.02 / $369.93
| Professional | | $82.81 | $138.02 | $369.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.54 / $57.57 / $155.97
| Professional | 26 | $34.54 | $57.57 | $155.97 |