- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $81.28 / $134.90
| Professional | | $70.79 | $81.28 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $50.12 / $123.03
| Professional | 26 | $41.69 | $50.12 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $81.28 / $95.50
| Professional | | $81.28 | $81.28 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $123.03 / $169.82
| Professional | | $81.28 | $123.03 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $75.86 / $97.72
| Professional | 26 | $53.70 | $75.86 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $100.00 / $281.84
| Professional | | $93.33 | $100.00 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.95 / $63.10 / $151.36
| Professional | 26 | $54.95 | $63.10 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $100.00 / $177.83
| Professional | | $74.13 | $100.00 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $64.57 / $100.00
| Professional | 26 | $45.71 | $64.57 | $100.00 |