- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.53 / $66.84 / $125.14
| Professional | | $59.53 | $66.84 | $125.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.86 / $37.39 / $66.06
| Professional | 26 | $36.86 | $37.39 | $66.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.68 / $83.60 / $140.43
| Professional | | $54.68 | $83.60 | $140.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.99 / $53.22 / $125.47
| Professional | 26 | $35.99 | $53.22 | $125.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.68 / $100.69 / $173.16
| Professional | | $54.68 | $100.69 | $173.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.42 / $42.31 / $81.25
| Professional | 26 | $33.42 | $42.31 | $81.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.37 / $108.46 / $123.42
| Professional | | $95.37 | $108.46 | $123.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.05 / $62.53 / $72.06
| Professional | 26 | $54.05 | $62.53 | $72.06 |