- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.84 / $181.09 / $780.15
| Professional | | $69.84 | $181.09 | $780.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.79 / $32.28 / $188.46
| Professional | 26 | $20.79 | $32.28 | $188.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.08 / $173.38 / $575.71
| Professional | | $147.08 | $173.38 | $575.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.19 / $128.72 / $575.71
| Professional | | $123.19 | $128.72 | $575.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.02 / $38.64 / $111.05
| Professional | 26 | $32.02 | $38.64 | $111.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.97 / $128.72 / $186.68
| Professional | | $85.97 | $128.72 | $186.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.23 / $32.53 / $41.91
| Professional | 26 | $25.23 | $32.53 | $41.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.48 / $114.13 / $408.27
| Professional | | $68.48 | $114.13 | $408.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.84 / $28.07 / $78.75
| Professional | 26 | $16.84 | $28.07 | $78.75 |