- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.60 / $346.06 / $593.73
| Professional | | $311.60 | $346.06 | $593.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.55 / $56.89 / $87.22
| Professional | 26 | $50.55 | $56.89 | $87.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.04 / $301.35 / $628.45
| Professional | | $239.04 | $301.35 | $628.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.42 / $63.86 / $101.85
| Professional | 26 | $48.42 | $63.86 | $101.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.05 / $349.05 / $349.05
| Professional | | $349.05 | $349.05 | $349.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.65 / $58.65 / $420.68
| Professional | 26 | $58.65 | $58.65 | $420.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.97 / $281.98 / $751.81
| Professional | | $208.97 | $281.98 | $751.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.63 / $59.85 / $131.66
| Professional | 26 | $41.63 | $59.85 | $131.66 |