- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.56 / $68.92 / $353.63
| Professional | | $60.56 | $68.92 | $353.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $42.22 / $197.61
| Professional | 26 | $37.15 | $42.22 | $197.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.81 / $87.74 / $258.70
| Professional | | $73.81 | $87.74 | $258.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.90 / $111.38 / $258.70
| Professional | | $73.90 | $111.38 | $258.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.09 / $69.52 / $130.44
| Professional | 26 | $47.09 | $69.52 | $130.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.48 / $101.98 / $154.32
| Professional | | $68.48 | $101.98 | $154.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.03 / $64.22 / $130.44
| Professional | 26 | $47.03 | $64.22 | $130.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.12 / $94.29 / $163.02
| Professional | | $64.12 | $94.29 | $163.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.65 / $57.02 / $154.04
| Professional | 26 | $41.65 | $57.02 | $154.04 |