- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $117.49 / $257.04
| Professional | | $85.11 | $117.49 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.20 / $23.99 / $74.13
| Professional | 26 | $18.20 | $23.99 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $114.82 / $114.82 / $114.82
| Professional | 26 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $123.03 / $257.04
| Professional | | $38.90 | $123.03 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $29.51 / $57.54
| Professional | 26 | $11.22 | $29.51 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $69.18 / $354.81
| Professional | | $45.71 | $69.18 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $25.12 / $69.18
| Professional | 26 | $12.88 | $25.12 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $165.96 / $1,023.29
| Professional | | $120.23 | $165.96 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.91 / $34.67 / $213.80
| Professional | 26 | $22.91 | $34.67 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $123.03 / $245.47
| Professional | | $26.92 | $123.03 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $114.82 / $316.23
| Professional | | $67.61 | $114.82 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.22 / $28.18 / $60.26
| Professional | 26 | $16.22 | $28.18 | $60.26 |