- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.41 / $95.11 / $114.57
| Professional | | $89.41 | $95.11 | $114.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.61 / $41.68 / $48.48
| Professional | 26 | $39.61 | $41.68 | $48.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.98 / $72.98 / $114.33
| Professional | | $72.98 | $72.98 | $114.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.82 / $29.82 / $70.44
| Professional | 26 | $29.82 | $29.82 | $70.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.52 / $72.78 / $143.63
| Professional | | $48.52 | $72.78 | $143.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.92 / $115.98 / $253.00
| Professional | | $64.92 | $115.98 | $253.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.30 / $50.83 / $114.16
| Professional | 26 | $27.30 | $50.83 | $114.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.06 / $137.86 / $234.36
| Professional | | $77.06 | $137.86 | $234.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.65 / $67.84 / $98.16
| Professional | 26 | $34.65 | $67.84 | $98.16 |