- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $114.82 / $151.36
| Professional | | $93.33 | $114.82 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $30.20 / $158.49
| Professional | 26 | $28.18 | $30.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $147.91 / $169.82
| Professional | | $54.95 | $147.91 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $36.31 / $95.50
| Professional | 26 | $34.67 | $36.31 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $66.07 / $169.82
| Professional | | $47.86 | $66.07 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $19.95 / $61.66
| Professional | 26 | $16.98 | $19.95 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $97.72 / $234.42
| Professional | | $58.88 | $97.72 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.42 / $33.88 / $87.10
| Professional | 26 | $20.42 | $33.88 | $87.10 |