- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.60 / $111.88 / $127.68
| Professional | | $96.60 | $111.88 | $127.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.17 / $23.56 / $35.28
| Professional | 26 | $20.17 | $23.56 | $35.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $137.91 / $137.91 / $137.91
| Facility | 26 | $137.91 | $137.91 | $137.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.99 / $155.57 / $528.79
| Professional | | $129.99 | $155.57 | $528.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.39 / $51.15 / $160.66
| Professional | 26 | $43.39 | $51.15 | $160.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.55 / $175.56 / $528.79
| Professional | | $137.55 | $175.56 | $528.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.28 / $47.16 / $160.66
| Professional | 26 | $31.28 | $47.16 | $160.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.96 / $155.88 / $528.79
| Professional | | $125.96 | $155.88 | $528.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.28 / $37.33 / $160.66
| Professional | 26 | $31.28 | $37.33 | $160.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.16 / $158.15 / $562.50
| Professional | | $111.16 | $158.15 | $562.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.55 / $53.02 / $154.50
| Professional | 26 | $30.55 | $53.02 | $154.50 |