- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $173.78 / $436.52
| Professional | | $141.25 | $173.78 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.66 / $75.86 / $204.17
| Professional | 26 | $61.66 | $75.86 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $371.54
| Professional | | $147.91 | $234.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $95.50 / $158.49
| Professional | 26 | $63.10 | $95.50 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.22 / $75.86 / $109.65
| Facility | 26 | $16.22 | $75.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $213.80 / $363.08
| Professional | | $154.88 | $213.80 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.18 / $93.33 / $158.49
| Professional | 26 | $69.18 | $93.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $281.84 / $501.19
| Professional | | $194.98 | $281.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $114.82 / $194.98
| Professional | 26 | $81.28 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $208.93 / $457.09
| Professional | | $154.88 | $208.93 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $93.33 / $208.93
| Professional | 26 | $64.57 | $93.33 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $218.78 / $354.81
| Professional | | $151.36 | $218.78 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $93.33 / $151.36
| Professional | 26 | $67.61 | $93.33 | $151.36 |