- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $204.17 / $234.42
| Professional | | $151.36 | $204.17 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.84 / $40.74 / $47.86
| Professional | 26 | $28.84 | $40.74 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $40.74 / $213.80
| Professional | | $40.74 | $40.74 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $213.80
| Professional | | $144.54 | $144.54 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $40.74 / $45.71
| Professional | 26 | $40.74 | $40.74 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $234.42 / $263.03
| Professional | | $173.78 | $234.42 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $199.53 / $309.03
| Professional | | $131.83 | $199.53 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $40.74 / $60.26
| Professional | 26 | $25.12 | $40.74 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $67.61 / $194.98
| Professional | | $53.70 | $67.61 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $16.98 / $45.71
| Professional | 26 | $16.98 | $16.98 | $45.71 |