- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.36 / $80.36 / $108.83
| Professional | | $80.36 | $80.36 | $108.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $33.11 / $45.48
| Professional | 26 | $33.11 | $33.11 | $45.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.78 / $80.78 / $258.83
| Professional | | $80.78 | $80.78 | $258.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.86 / $35.86 / $107.73
| Professional | 26 | $35.86 | $35.86 | $107.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.80 / $140.13 / $308.31
| Professional | | $96.80 | $140.13 | $308.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.08 / $55.42 / $128.35
| Professional | 26 | $38.08 | $55.42 | $128.35 |