- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $281.84 / $457.09
| Professional | | $213.80 | $281.84 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $64.57 / $91.20
| Professional | 26 | $57.54 | $64.57 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $870.96
| Professional | | $281.84 | $281.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $537.03 / $912.01
| Professional | | $269.15 | $537.03 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $89.13 / $190.55
| Professional | 26 | $77.62 | $89.13 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $870.96
| Professional | | $288.40 | $288.40 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $63.10 / $251.19
| Professional | 26 | $63.10 | $63.10 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $457.09 / $724.44
| Professional | | $229.09 | $457.09 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $83.18 / $204.17
| Professional | 26 | $61.66 | $83.18 | $204.17 |