- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.83 / $236.99 / $262.89
| Professional | | $100.83 | $236.99 | $262.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.48 / $66.79 / $74.08
| Professional | 26 | $29.48 | $66.79 | $74.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.22 / $159.22 / $159.22
| Professional | | $159.22 | $159.22 | $159.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.31 / $111.32 / $201.81
| Professional | | $53.31 | $111.32 | $201.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.48 / $42.33 / $74.19
| Professional | 26 | $17.48 | $42.33 | $74.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.68 / $140.38 / $333.82
| Professional | | $60.68 | $140.38 | $333.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.70 / $40.42 / $85.48
| Professional | 26 | $21.70 | $40.42 | $85.48 |