- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $112.20 / $234.42
| Professional | | $85.11 | $112.20 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.20 / $26.92 / $48.98
| Professional | 26 | $18.20 | $26.92 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Professional | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $89.13 / $199.53
| Professional | | $50.12 | $89.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.30 / $29.51 / $53.70
| Professional | 26 | $12.30 | $29.51 | $53.70 |
- 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
- $57.54 / $114.82 / $251.19
| Professional | | $57.54 | $114.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.22 / $28.18 / $56.23
| Professional | 26 | $16.22 | $28.18 | $56.23 |