- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.78 / $165.37 / $229.69
| Professional | | $141.78 | $165.37 | $229.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.35 / $69.56 / $94.51
| Professional | 26 | $61.35 | $69.56 | $94.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.79 / $178.58 / $247.30
| Professional | | $151.79 | $178.58 | $247.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.19 / $75.98 / $75.98
| Professional | 26 | $53.19 | $75.98 | $75.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.47 / $240.52 / $359.19
| Professional | | $156.47 | $240.52 | $359.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.98 / $101.15 / $155.82
| Professional | 26 | $69.98 | $101.15 | $155.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $177.29 / $265.27
| Professional | | $138.04 | $177.29 | $265.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $62.81 / $81.28 / $118.22
| Professional | 26 | $62.81 | $81.28 | $118.22 |