- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.14 / $352.88 / $442.27
| Professional | | $284.14 | $352.88 | $442.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $103.22 / $116.15 / $489.00
| Professional | 26 | $103.22 | $116.15 | $489.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.65 / $393.31 / $393.31
| Professional | | $333.65 | $393.31 | $393.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.95 / $517.04 / $869.73
| Professional | | $344.95 | $517.04 | $869.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $149.10 / $220.09 / $382.80
| Professional | 26 | $149.10 | $220.09 | $382.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.99 / $517.04 / $869.73
| Professional | | $396.99 | $517.04 | $869.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $164.16 / $216.41 / $382.80
| Professional | 26 | $164.16 | $216.41 | $382.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.10 / $388.25 / $1,015.75
| Professional | | $254.10 | $388.25 | $1,015.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.60 / $156.03 / $451.31
| Professional | 26 | $112.60 | $156.03 | $451.31 |