- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $169.82 / $346.74
| Professional | | $144.54 | $169.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $75.86 / $269.15
| Professional | 26 | $61.66 | $75.86 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $223.87 / $562.34
| Professional | | $186.21 | $223.87 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $213.80 / $660.69
| Professional | | $181.97 | $213.80 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $97.72 / $281.84
| Professional | 26 | $77.62 | $97.72 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $229.09 / $562.34
| Professional | | $162.18 | $229.09 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $97.72 / $239.88
| Professional | 26 | $74.13 | $97.72 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $218.78 / $398.11
| Professional | | $144.54 | $218.78 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $100.00 / $151.36
| Professional | 26 | $63.10 | $100.00 | $151.36 |