- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.37 / $98.99 / $106.49
| Professional | | $95.37 | $98.99 | $106.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.47 / $42.68 / $42.68
| Professional | 26 | $40.47 | $42.68 | $42.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.61 / $144.05 / $242.76
| Professional | | $121.61 | $144.05 | $242.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.44 / $59.13 / $99.56
| Professional | 26 | $51.44 | $59.13 | $99.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.61 / $134.75 / $242.76
| Professional | | $121.61 | $134.75 | $242.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.75 / $59.13 / $95.52
| Professional | 26 | $52.75 | $59.13 | $95.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.35 / $192.21 / $408.41
| Professional | | $109.35 | $192.21 | $408.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.67 / $59.99 / $160.69
| Professional | 26 | $43.67 | $59.99 | $160.69 |