- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.02 / $480.08 / $604.77
| Professional | | $307.02 | $480.08 | $604.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.35 / $67.33 / $85.94
| Professional | 26 | $57.35 | $67.33 | $85.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.99 / $82.99 / $91.90
| Professional | 26 | $82.99 | $82.99 | $91.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $472.00
| Professional | | $400.00 | $400.00 | $472.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $135.22 / $150.24 / $177.28
| Professional | 26 | $135.22 | $150.24 | $177.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.47 / $212.91 / $696.40
| Professional | | $156.47 | $212.91 | $696.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.04 / $39.13 / $491.65
| Professional | 26 | $35.04 | $39.13 | $491.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.53 / $236.46 / $522.51
| Professional | | $213.53 | $236.46 | $522.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.09 / $58.03 / $80.34
| Professional | 26 | $46.09 | $58.03 | $80.34 |