- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.79 / $116.32 / $159.94
| Professional | | $102.79 | $116.32 | $159.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.94 / $49.99 / $69.64
| Professional | 26 | $43.94 | $49.99 | $69.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.51 / $126.09 / $166.89
| Professional | | $49.51 | $126.09 | $166.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.11 / $66.02 / $82.52
| Professional | 26 | $56.11 | $66.02 | $82.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.04 / $120.19 / $221.49
| Professional | | $60.04 | $120.19 | $221.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.00 / $56.81 / $98.73
| Professional | 26 | $25.00 | $56.81 | $98.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.47 / $130.97 / $179.22
| Professional | | $72.47 | $130.97 | $179.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.72 / $53.68 / $80.09
| Professional | 26 | $32.72 | $53.68 | $80.09 |