- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.25 / $164.55 / $427.08
| Professional | | $149.25 | $164.55 | $427.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.77 / $423.01 / $474.45
| Professional | | $291.77 | $423.01 | $474.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.48 / $448.48 / $888.82
| Professional | | $279.48 | $448.48 | $888.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.63 / $441.49 / $693.29
| Professional | | $347.63 | $441.49 | $693.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $59.28 / $74.88 / $98.85
| Professional | 26 | $59.28 | $74.88 | $98.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.69 / $377.22 / $703.24
| Professional | | $253.69 | $377.22 | $703.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.06 / $200.31 / $248.06
| Professional | | $136.06 | $200.31 | $248.06 |