- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.36 / $280.44 / $413.85
| Professional | | $215.36 | $280.44 | $413.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.51 / $61.13 / $90.99
| Professional | 26 | $57.51 | $61.13 | $90.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.14 / $282.30 / $413.28
| Professional | | $218.14 | $282.30 | $413.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.09 / $81.00 / $123.02
| Professional | 26 | $58.09 | $81.00 | $123.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.17 / $395.33 / $636.84
| Professional | | $268.17 | $395.33 | $636.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.97 / $96.39 / $135.37
| Professional | 26 | $60.97 | $96.39 | $135.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.50 / $296.62 / $535.10
| Professional | | $246.50 | $296.62 | $535.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.37 / $88.29 / $159.27
| Professional | 26 | $73.37 | $88.29 | $159.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.36 / $354.90 / $599.49
| Professional | | $215.36 | $354.90 | $599.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.51 / $72.62 / $131.61
| Professional | 26 | $57.51 | $72.62 | $131.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.86 / $367.42 / $544.14
| Professional | | $233.86 | $367.42 | $544.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.70 / $90.67 / $160.01
| Professional | 26 | $62.70 | $90.67 | $160.01 |