- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.80 / $135.22 / $159.06
| Professional | | $100.80 | $135.22 | $159.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.73 / $32.79 / $39.61
| Professional | 26 | $27.73 | $32.79 | $39.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.20 / $164.20 / $396.15
| Professional | | $164.20 | $164.20 | $396.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.05 / $135.38 / $230.00
| Professional | | $65.05 | $135.38 | $230.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.59 / $47.91 / $74.28
| Professional | 26 | $19.59 | $47.91 | $74.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.57 / $180.63 / $1,357.00
| Professional | | $97.57 | $180.63 | $1,357.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.65 / $55.91 / $271.00
| Professional | 26 | $34.65 | $55.91 | $271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.57 / $139.21 / $185.23
| Professional | | $97.57 | $139.21 | $185.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.25 / $39.90 / $56.05
| Professional | 26 | $24.25 | $39.90 | $56.05 |