- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.07 / $54.14 / $164.00
| Professional | | $34.07 | $54.14 | $164.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.53 / $24.19 / $122.46
| Professional | 26 | $20.53 | $24.19 | $122.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.32 / $53.32 / $197.21
| Professional | | $53.32 | $53.32 | $197.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.94 / $74.47 / $197.21
| Professional | | $41.94 | $74.47 | $197.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.72 / $40.01 / $80.11
| Professional | 26 | $26.72 | $40.01 | $80.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.04 / $68.86 / $114.28
| Professional | | $40.04 | $68.86 | $114.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.72 / $39.32 / $80.11
| Professional | 26 | $26.72 | $39.32 | $80.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.56 / $54.76 / $198.94
| Professional | | $49.56 | $54.76 | $198.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.63 / $31.92 / $95.93
| Professional | 26 | $22.63 | $31.92 | $95.93 |