- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.99 / $161.19 / $168.98
| Professional | | $135.99 | $161.19 | $168.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $310.83 / $310.83 / $310.83
| Facility | 26 | $310.83 | $310.83 | $310.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.92 / $195.58 / $561.03
| Professional | | $165.92 | $195.58 | $561.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.91 / $192.31 / $561.03
| Professional | | $178.91 | $192.31 | $561.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.91 / $192.31 / $561.03
| Professional | | $178.91 | $192.31 | $561.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.21 / $178.72 / $596.79
| Professional | | $130.21 | $178.72 | $596.79 |