- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.13 / $127.90 / $960.45
| Professional | | $85.13 | $127.90 | $960.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.45 / $42.39 / $270.95
| Professional | 26 | $26.45 | $42.39 | $270.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.69 / $164.45 / $200.07
| Professional | | $123.69 | $164.45 | $200.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.55 / $51.40 / $161.18
| Professional | 26 | $43.55 | $51.40 | $161.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.98 / $154.84 / $200.07
| Professional | | $109.98 | $154.84 | $200.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.58 / $45.96 / $54.80
| Professional | 26 | $35.58 | $45.96 | $54.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.40 / $140.66 / $482.40
| Professional | | $84.40 | $140.66 | $482.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.22 / $40.36 / $114.30
| Professional | 26 | $24.22 | $40.36 | $114.30 |