- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.39 / $437.48 / $807.35
| Professional | | $308.39 | $437.48 | $807.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.13 / $80.62 / $148.78
| Professional | 26 | $59.13 | $80.62 | $148.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $172.90 / $172.90 / $172.90
| Professional | 26 | $172.90 | $172.90 | $172.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.87 / $649.87 / $649.87
| Professional | | $649.87 | $649.87 | $649.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.11 / $378.65 / $999.85
| Professional | | $172.11 | $378.65 | $999.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.31 / $83.47 / $151.76
| Professional | 26 | $35.31 | $83.47 | $151.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.67 / $433.51 / $920.20
| Professional | | $210.67 | $433.51 | $920.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.69 / $79.76 / $173.75
| Professional | 26 | $45.69 | $79.76 | $173.75 |