- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.90 / $154.31 / $204.40
| Professional | | $137.90 | $154.31 | $204.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.08 / $134.08 / $238.19
| Professional | | $134.08 | $134.08 | $238.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $134.08 / $134.08 / $159.38
| Facility | 26 | $134.08 | $134.08 | $159.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.82 / $214.37 / $633.04
| Professional | | $154.82 | $214.37 | $633.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $134.08 / $134.08 / $159.38
| Facility | 26 | $134.08 | $134.08 | $159.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.28 / $238.19 / $359.00
| Professional | | $144.28 | $238.19 | $359.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.48 / $251.34 / $307.48
| Professional | | $204.48 | $251.34 | $307.48 |