- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $117.49 / $524.81
| Professional | | $89.13 | $117.49 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $48.98 / $208.93
| Professional | 26 | $34.67 | $48.98 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $194.98 / $380.19
| Professional | | $151.36 | $194.98 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $83.18 / $158.49
| Professional | 26 | $63.10 | $83.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $144.54 / $295.12
| Professional | | $74.13 | $144.54 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $58.88 / $117.49
| Professional | 26 | $30.20 | $58.88 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $213.80 / $295.12
| Professional | | $125.89 | $213.80 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.29 / $70.79 / $93.33
| Professional | 26 | $51.29 | $70.79 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $199.53 / $416.87
| Professional | | $83.18 | $199.53 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $79.43 / $169.82
| Professional | 26 | $36.31 | $79.43 | $169.82 |