- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.49 / $136.22 / $136.94
| Professional | | $90.49 | $136.22 | $136.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.69 / $55.27 / $60.59
| Professional | 26 | $39.69 | $55.27 | $60.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.58 / $128.58 / $151.72
| Professional | | $128.58 | $128.58 | $151.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.49 / $55.50 / $65.48
| Professional | 26 | $55.49 | $55.50 | $65.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.65 / $65.09 / $222.05
| Professional | | $55.65 | $65.09 | $222.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.35 / $36.54 / $101.13
| Professional | 26 | $24.35 | $36.54 | $101.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.12 / $120.01 / $184.38
| Professional | | $76.12 | $120.01 | $184.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.47 / $57.55 / $76.19
| Professional | 26 | $33.47 | $57.55 | $76.19 |