- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.55 / $183.11 / $290.43
| Professional | | $155.55 | $183.11 | $290.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.20 / $75.20 / $118.85
| Professional | 26 | $58.20 | $75.20 | $118.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.50 / $197.23 / $335.10
| Professional | | $169.50 | $197.23 | $335.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $75.80 / $89.18 / $143.69
| Professional | 26 | $75.80 | $89.18 | $143.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.47 / $244.84 / $387.48
| Professional | | $168.47 | $244.84 | $387.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.58 / $110.63 / $166.38
| Professional | 26 | $74.58 | $110.63 | $166.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.99 / $258.77 / $383.36
| Professional | | $215.99 | $258.77 | $383.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.57 / $112.11 / $166.08
| Professional | 26 | $93.57 | $112.11 | $166.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.55 / $188.48 / $293.26
| Professional | | $155.55 | $188.48 | $293.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.59 / $77.90 / $118.18
| Professional | 26 | $67.59 | $77.90 | $118.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.39 / $231.97 / $358.96
| Professional | | $167.39 | $231.97 | $358.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.48 / $110.39 / $152.59
| Professional | 26 | $77.48 | $110.39 | $152.59 |