- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $113.14 / $113.14 / $169.71
| Facility | 26 | $113.14 | $113.14 | $169.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.84 / $163.72 / $205.56
| Professional | | $140.84 | $163.72 | $205.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.70 / $174.70 / $174.70
| Professional | | $174.70 | $174.70 | $174.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.72 / $195.51 / $195.51
| Professional | | $147.72 | $195.51 | $195.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.97 / $207.60 / $283.08
| Professional | | $133.97 | $207.60 | $283.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.91 / $200.91 / $200.91
| Professional | | $200.91 | $200.91 | $200.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.41 / $182.30 / $273.33
| Professional | | $129.41 | $182.30 | $273.33 |