- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $114.82 / $223.87
| Professional | | $85.11 | $114.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.05 / $23.99 / $45.71
| Professional | 26 | $19.05 | $23.99 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $117.49 / $162.18
| Professional | | $26.30 | $117.49 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $67.61 / $223.87
| Professional | | $43.65 | $67.61 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.59 / $27.54 / $45.71
| Professional | 26 | $12.59 | $27.54 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $134.90 / $891.25
| Professional | | $58.88 | $134.90 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.85 / $37.15 / $239.88
| Professional | 26 | $15.85 | $37.15 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $87.10 / $218.78
| Professional | | $48.98 | $87.10 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.49 / $26.30 / $44.67
| Professional | 26 | $15.49 | $26.30 | $44.67 |