- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.16 / $252.81 / $258.99
| Professional | | $242.16 | $252.81 | $258.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.01 / $60.34 / $63.06
| Professional | 26 | $58.01 | $60.34 | $63.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.48 / $388.20 / $953.79
| Professional | | $223.48 | $388.20 | $953.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.84 / $74.33 / $196.29
| Professional | 26 | $52.84 | $74.33 | $196.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.48 / $363.12 / $953.79
| Professional | | $223.48 | $363.12 | $953.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.84 / $74.33 / $196.29
| Professional | 26 | $52.84 | $74.33 | $196.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.08 / $340.93 / $1,170.68
| Professional | | $261.08 | $340.93 | $1,170.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.27 / $81.04 / $123.70
| Professional | 26 | $72.27 | $81.04 | $123.70 |