- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $77.62 / $147.91
| Professional | | $57.54 | $77.62 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $43.65 / $81.28
| Professional | 26 | $37.15 | $43.65 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Professional | | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $41.69 / $70.79
| Professional | 26 | $41.69 | $41.69 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $74.13 / $93.33
| Professional | | $53.70 | $74.13 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $41.69 / $48.98
| Professional | 26 | $30.20 | $41.69 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $95.50 / $213.80
| Professional | | $72.44 | $95.50 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.86 / $63.10 / $128.82
| Professional | 26 | $47.86 | $63.10 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $69.18 / $109.65
| Professional | | $51.29 | $69.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $42.66 / $64.57
| Professional | 26 | $32.36 | $42.66 | $64.57 |