- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.71 / $104.33 / $123.77
| Professional | | $88.71 | $104.33 | $123.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.36 / $44.83 / $54.34
| Professional | 26 | $39.36 | $44.83 | $54.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.25 / $187.25 / $187.25
| Professional | | $187.25 | $187.25 | $187.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.00 / $235.04 / $272.64
| Professional | | $69.00 | $235.04 | $272.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.39 / $95.38 / $113.00
| Professional | 26 | $28.39 | $95.38 | $113.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.38 / $183.67 / $1,000.49
| Professional | | $131.38 | $183.67 | $1,000.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.00 / $76.31 / $415.79
| Professional | 26 | $56.00 | $76.31 | $415.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.72 / $155.10 / $188.03
| Professional | | $82.72 | $155.10 | $188.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.65 / $58.51 / $80.84
| Professional | 26 | $34.65 | $58.51 | $80.84 |