- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $117.49 / $213.80
| Professional | | $102.33 | $117.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $48.98 / $87.10
| Professional | 26 | $40.74 | $48.98 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $177.83 / $288.40
| Professional | | $120.23 | $177.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $79.43 / $120.23
| Professional | 26 | $50.12 | $79.43 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $123.03 / $190.55
| Professional | | $120.23 | $123.03 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $50.12 / $79.43
| Professional | 26 | $50.12 | $50.12 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $138.04 / $371.54
| Professional | | $83.18 | $138.04 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $57.54 / $154.88
| Professional | 26 | $34.67 | $57.54 | $154.88 |