- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.43 / $352.88 / $509.07
| Professional | | $330.43 | $352.88 | $509.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $103.47 / $116.15 / $344.70
| Professional | 26 | $103.47 | $116.15 | $344.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.52 / $163.52 / $371.21
| Professional | | $163.52 | $163.52 | $371.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $163.52 / $163.52 / $194.38
| Facility | 26 | $163.52 | $163.52 | $194.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.81 / $380.73 / $634.66
| Professional | | $277.81 | $380.73 | $634.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $118.26 / $163.52 / $238.20
| Professional | 26 | $118.26 | $163.52 | $238.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $163.52 / $163.52 / $194.38
| Facility | 26 | $163.52 | $163.52 | $194.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.26 / $421.79 / $712.21
| Professional | | $250.26 | $421.79 | $712.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $129.10 / $163.52 / $200.21
| Professional | 26 | $129.10 | $163.52 | $200.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.96 / $417.59 / $549.76
| Professional | | $354.96 | $417.59 | $549.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $146.63 / $182.32 / $202.80
| Professional | 26 | $146.63 | $182.32 | $202.80 |