- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.25 / $176.50 / $256.79
| Professional | | $164.25 | $176.50 | $256.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.51 / $72.18 / $296.00
| Professional | 26 | $64.51 | $72.18 | $296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.19 / $221.84 / $558.60
| Professional | | $188.19 | $221.84 | $558.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.50 / $214.84 / $558.60
| Professional | | $180.50 | $214.84 | $558.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.02 / $94.85 / $242.53
| Professional | 26 | $77.02 | $94.85 | $242.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.50 / $230.48 / $558.60
| Professional | | $180.50 | $230.48 | $558.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.02 / $97.48 / $242.53
| Professional | 26 | $77.02 | $97.48 | $242.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.28 / $226.24 / $657.70
| Professional | | $154.28 | $226.24 | $657.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.23 / $99.57 / $287.95
| Professional | 26 | $68.23 | $99.57 | $287.95 |