- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.69 / $114.13 / $127.25
| Professional | | $101.69 | $114.13 | $127.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.20 / $25.24 / $33.79
| Professional | 26 | $22.20 | $25.24 | $33.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.99 / $23.99 / $23.99
| Professional | 26 | $11.99 | $23.99 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.89 / $90.11 / $119.26
| Professional | | $23.89 | $90.11 | $119.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.07 / $31.85 / $39.81
| Professional | 26 | $27.07 | $31.85 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.88 / $103.11 / $175.19
| Professional | | $45.88 | $103.11 | $175.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.79 / $27.56 / $44.40
| Professional | 26 | $12.79 | $27.56 | $44.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.66 / $77.50 / $147.78
| Professional | | $47.66 | $77.50 | $147.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.81 / $19.75 / $37.20
| Professional | 26 | $14.81 | $19.75 | $37.20 |