- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.84 / $97.15 / $136.41
| Professional | | $66.84 | $97.15 | $136.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.88 / $49.74 / $60.89
| Professional | 26 | $37.88 | $49.74 | $60.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.51 / $99.99 / $122.57
| Professional | | $64.51 | $99.99 | $122.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.29 / $55.26 / $72.34
| Professional | 26 | $39.29 | $55.26 | $72.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.39 / $111.01 / $134.56
| Professional | | $79.39 | $111.01 | $134.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.07 / $56.03 / $67.92
| Professional | 26 | $40.07 | $56.03 | $67.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $110.01
| Professional | | $32.34 | $32.34 | $110.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.06 / $72.06 / $72.06
| Facility | 26 | $72.06 | $72.06 | $72.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.96 / $103.48 / $138.84
| Professional | | $87.96 | $103.48 | $138.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.98 / $51.74 / $73.55
| Professional | 26 | $43.98 | $51.74 | $73.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.02 / $84.78 / $115.60
| Professional | | $64.02 | $84.78 | $115.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.60 / $50.59 / $72.06
| Professional | 26 | $39.60 | $50.59 | $72.06 |