- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.32 / $110.76 / $148.08
| Professional | | $93.32 | $110.76 | $148.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.61 / $48.48 / $64.81
| Professional | 26 | $39.61 | $48.48 | $64.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.69 / $178.82 / $209.37
| Professional | | $76.69 | $178.82 | $209.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.52 / $138.49 / $201.01
| Professional | | $58.52 | $138.49 | $201.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.27 / $39.24 / $83.89
| Professional | 26 | $23.27 | $39.24 | $83.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.00 / $176.65 / $240.35
| Professional | | $137.00 | $176.65 | $240.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.49 / $72.64 / $102.45
| Professional | 26 | $57.49 | $72.64 | $102.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.47 / $75.43 / $146.84
| Professional | | $34.47 | $75.43 | $146.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.72 / $151.65 / $215.85
| Professional | | $82.72 | $151.65 | $215.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.65 / $57.74 / $93.80
| Professional | 26 | $34.65 | $57.74 | $93.80 |