- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.55 / $604.77 / $804.49
| Professional | | $586.55 | $604.77 | $804.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.11 / $71.44 / $202.44
| Professional | 26 | $62.11 | $71.44 | $202.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.89 / $484.13 / $1,020.16
| Professional | | $283.89 | $484.13 | $1,020.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.79 / $94.73 / $181.41
| Professional | 26 | $35.79 | $94.73 | $181.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.04 / $579.75 / $1,099.04
| Professional | | $482.04 | $579.75 | $1,099.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $80.08 / $88.98 / $130.57
| Professional | 26 | $80.08 | $88.98 | $130.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.24 / $394.10 / $730.82
| Professional | | $209.24 | $394.10 | $730.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.55 / $79.76 / $143.57
| Professional | 26 | $45.55 | $79.76 | $143.57 |