- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.83 / $252.81 / $597.04
| Professional | | $225.83 | $252.81 | $597.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.87 / $54.69 / $69.88
| Professional | 26 | $46.87 | $54.69 | $69.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.50 / $325.99 / $415.38
| Professional | | $298.50 | $325.99 | $415.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.21 / $53.16 / $100.55
| Professional | 26 | $37.21 | $53.16 | $100.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.45 / $403.92 / $576.98
| Professional | | $248.45 | $403.92 | $576.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.56 / $66.45 / $111.56
| Professional | 26 | $42.56 | $66.45 | $111.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.85 / $299.58 / $507.14
| Professional | | $234.85 | $299.58 | $507.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.90 / $67.06 / $95.96
| Professional | 26 | $53.90 | $67.06 | $95.96 |