- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $81.28 / $120.23
| Professional | | $70.79 | $81.28 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $43.65 / $63.10
| Professional | 26 | $39.81 | $43.65 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $134.90 / $134.90
| Professional | | $109.65 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $72.44 / $72.44
| Professional | 26 | $58.88 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $102.33 / $131.83
| Professional | | $81.28 | $102.33 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $63.10 / $85.11
| Professional | 26 | $53.70 | $63.10 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $117.49 / $208.93
| Professional | | $85.11 | $117.49 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $75.86 / $138.04
| Professional | 26 | $57.54 | $75.86 | $138.04 |