- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $128.82 / $151.36
| Professional | | $83.18 | $128.82 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.85 / $22.39 / $64.57
| Professional | 26 | $15.85 | $22.39 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $204.17 / $208.93
| Professional | | $138.04 | $204.17 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.54 / $40.74 / $40.74
| Professional | 26 | $27.54 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $229.09 / $309.03
| Professional | | $77.62 | $229.09 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.88 / $48.98 / $60.26
| Professional | 26 | $21.88 | $48.98 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $125.89 / $891.25
| Professional | | $79.43 | $125.89 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.22 / $26.92 / $239.88
| Professional | 26 | $16.22 | $26.92 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $234.42 / $316.23
| Professional | | $165.96 | $234.42 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $48.98 / $63.10
| Professional | 26 | $45.71 | $48.98 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $316.23
| Professional | | $302.00 | $302.00 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $60.26 / $63.10
| Professional | 26 | $58.88 | $60.26 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $120.23 / $229.09
| Professional | | $100.00 | $120.23 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.99 / $26.92 / $53.70
| Professional | 26 | $23.99 | $26.92 | $53.70 |