- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.53 / $88.71 / $123.77
| Professional | | $87.53 | $88.71 | $123.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.84 / $39.36 / $54.34
| Professional | 26 | $38.84 | $39.36 | $54.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.55 / $123.20 / $169.17
| Professional | | $53.55 | $123.20 | $169.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.41 / $86.28 / $253.00
| Professional | | $63.41 | $86.28 | $253.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.92 / $45.87 / $115.50
| Professional | 26 | $27.92 | $45.87 | $115.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.73 / $206.79 / $1,000.49
| Professional | | $81.73 | $206.79 | $1,000.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.38 / $77.36 / $415.79
| Professional | 26 | $34.38 | $77.36 | $415.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.73 / $94.82 / $217.97
| Professional | | $81.73 | $94.82 | $217.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.38 / $57.74 / $106.59
| Professional | 26 | $34.38 | $57.74 | $106.59 |