- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.69 / $363.40 / $460.80
| Professional | | $287.69 | $363.40 | $460.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.46 / $71.06 / $71.66
| Professional | 26 | $52.46 | $71.06 | $71.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.38 / $449.56 / $1,108.70
| Professional | | $381.38 | $449.56 | $1,108.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.73 / $536.72 / $1,108.70
| Professional | | $369.73 | $536.72 | $1,108.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.09 / $84.90 / $242.44
| Professional | 26 | $75.09 | $84.90 | $242.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.73 / $534.42 / $1,108.70
| Professional | | $369.73 | $534.42 | $1,108.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.22 / $84.90 / $242.44
| Professional | 26 | $79.22 | $84.90 | $242.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.22 / $551.66 / $1,179.35
| Professional | | $282.22 | $551.66 | $1,179.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.81 / $86.32 / $231.23
| Professional | 26 | $59.81 | $86.32 | $231.23 |