- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.93 / $75.34 / $177.68
| Professional | | $64.93 | $75.34 | $177.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.25 / $50.14 / $205.00
| Professional | 26 | $42.25 | $50.14 | $205.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.39 / $94.81 / $281.17
| Professional | | $80.39 | $94.81 | $281.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.84 / $121.75 / $281.17
| Professional | | $80.84 | $121.75 | $281.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.04 / $79.76 / $151.68
| Professional | 26 | $54.04 | $79.76 | $151.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.84 / $111.63 / $281.17
| Professional | | $80.84 | $111.63 | $281.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.04 / $73.64 / $151.68
| Professional | 26 | $54.04 | $73.64 | $151.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.19 / $102.69 / $297.02
| Professional | | $79.19 | $102.69 | $297.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.17 / $65.44 / $178.34
| Professional | 26 | $42.17 | $65.44 | $178.34 |