- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.87 / $252.81 / $360.65
| Professional | | $205.87 | $252.81 | $360.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.75 / $59.63 / $71.36
| Professional | 26 | $46.75 | $59.63 | $71.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.00 / $505.00 / $505.00
| Professional | | $409.00 | $505.00 | $505.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.00 / $95.00 / $95.00
| Professional | 26 | $77.00 | $95.00 | $95.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.76 / $339.69 / $641.38
| Professional | | $269.76 | $339.69 | $641.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.51 / $90.31 / $138.87
| Professional | 26 | $56.51 | $90.31 | $138.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.95 / $425.28 / $704.00
| Professional | | $256.95 | $425.28 | $704.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.41 / $103.93 / $172.69
| Professional | 26 | $71.41 | $103.93 | $172.69 |