- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.78 / $164.26 / $212.87
| Professional | | $157.78 | $164.26 | $212.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.51 / $64.51 / $86.33
| Professional | 26 | $64.51 | $64.51 | $86.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.00 / $226.00 / $278.00
| Professional | | $226.00 | $226.00 | $278.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.00 / $97.00 / $119.00
| Professional | 26 | $97.00 | $97.00 | $119.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.79 / $234.17 / $435.12
| Professional | | $160.79 | $234.17 | $435.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.77 / $98.16 / $176.52
| Professional | 26 | $69.77 | $98.16 | $176.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.27 / $269.99 / $519.67
| Professional | | $158.27 | $269.99 | $519.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $79.00 / $123.39 / $229.82
| Professional | 26 | $79.00 | $123.39 | $229.82 |