- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.14 / $696.46 / $2,706.71
| Professional | | $276.14 | $696.46 | $2,706.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.80 / $67.28 / $118.48
| Professional | 26 | $57.80 | $67.28 | $118.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.97 / $625.97 / $737.88
| Professional | | $625.97 | $625.97 | $737.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.12 / $760.48 / $1,057.06
| Professional | | $478.12 | $760.48 | $1,057.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.09 / $108.07 / $319.52
| Professional | 26 | $91.09 | $108.07 | $319.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.66 / $677.44 / $1,057.06
| Professional | | $454.66 | $677.44 | $1,057.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.78 / $93.80 / $114.36
| Professional | 26 | $72.78 | $93.80 | $114.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.35 / $400.13 / $1,424.97
| Professional | | $237.35 | $400.13 | $1,424.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.79 / $91.96 / $226.59
| Professional | 26 | $47.79 | $91.96 | $226.59 |