- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.93 / $142.66 / $271.75
| Professional | | $102.93 | $142.66 | $271.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.79 / $35.40 / $158.65
| Professional | 26 | $28.79 | $35.40 | $158.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.95 / $227.55 / $266.43
| Professional | | $73.95 | $227.55 | $266.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.41 / $94.41 / $218.11
| Professional | | $61.41 | $94.41 | $218.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.64 / $32.93 / $106.34
| Professional | 26 | $16.64 | $32.93 | $106.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.69 / $114.14 / $263.52
| Professional | | $99.69 | $114.14 | $263.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.46 / $34.61 / $60.75
| Professional | 26 | $33.46 | $34.61 | $60.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.47 / $138.18 / $185.31
| Professional | | $34.47 | $138.18 | $185.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.26 / $99.21 / $187.94
| Professional | | $64.26 | $99.21 | $187.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.55 / $35.58 / $56.59
| Professional | 26 | $22.55 | $35.58 | $56.59 |