- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.13 / $278.20 / $479.54
| Professional | | $231.13 | $278.20 | $479.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.29 / $289.01 / $409.57
| Professional | | $272.29 | $289.01 | $409.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.10 / $379.95 / $849.93
| Professional | | $269.10 | $379.95 | $849.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.12 / $324.16 / $477.31
| Professional | | $254.12 | $324.16 | $477.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $208.57 / $268.33 / $396.99
| Professional | 26 | $208.57 | $268.33 | $396.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.35 / $325.54 / $487.44
| Professional | | $239.35 | $325.54 | $487.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.68 / $267.68 / $408.35
| Professional | | $267.68 | $267.68 | $408.35 |