- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.52 / $404.16 / $513.25
| Professional | | $336.52 | $404.16 | $513.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.03 / $91.03 / $106.55
| Professional | 26 | $78.03 | $91.03 | $106.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.79 / $530.20 / $1,316.58
| Professional | | $449.79 | $530.20 | $1,316.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.41 / $653.51 / $1,316.58
| Professional | | $435.41 | $653.51 | $1,316.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.85 / $125.74 / $355.86
| Professional | 26 | $112.85 | $125.74 | $355.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.41 / $622.05 / $1,316.58
| Professional | | $435.41 | $622.05 | $1,316.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $116.11 / $125.74 / $355.86
| Professional | 26 | $116.11 | $125.74 | $355.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.82 / $681.73 / $1,251.64
| Professional | | $366.82 | $681.73 | $1,251.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $88.76 / $118.48 / $339.34
| Professional | 26 | $88.76 | $118.48 | $339.34 |