- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $125.89 / $239.88
| Professional | | $95.50 | $125.89 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $50.12 / $120.23
| Professional | 26 | $32.36 | $50.12 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $75.86 / $169.82
| Professional | | $75.86 | $75.86 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $75.86 / $93.33
| Facility | 26 | $75.86 | $75.86 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $158.49 / $257.04
| Professional | | $79.43 | $158.49 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $46.77 / $91.20
| Professional | 26 | $30.20 | $46.77 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $190.55 / $281.84
| Professional | | $181.97 | $190.55 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $75.86 / $75.86 / $93.33
| Facility | 26 | $75.86 | $75.86 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $245.47 / $295.12
| Professional | | $151.36 | $245.47 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $67.61 / $109.65
| Professional | 26 | $34.67 | $67.61 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $117.49 / $194.98
| Professional | | $109.65 | $117.49 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $35.48 / $61.66
| Professional | 26 | $34.67 | $35.48 | $61.66 |