- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.59 / $140.97 / $224.10
| Professional | | $137.59 | $140.97 | $224.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.05 / $25.36 / $34.24
| Professional | 26 | $23.05 | $25.36 | $34.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.07 / $158.91 / $247.35
| Professional | | $132.07 | $158.91 | $247.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.00 / $24.96 / $43.87
| Professional | 26 | $22.00 | $24.96 | $43.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.93 / $202.69 / $334.43
| Professional | | $161.93 | $202.69 | $334.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.71 / $32.59 / $51.31
| Professional | 26 | $24.71 | $32.59 | $51.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.48 / $213.84 / $349.91
| Professional | | $178.48 | $213.84 | $349.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.03 / $33.58 / $49.75
| Professional | 26 | $28.03 | $33.58 | $49.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.59 / $140.97 / $251.02
| Professional | | $137.59 | $140.97 | $251.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.05 / $25.39 / $41.67
| Professional | 26 | $23.05 | $25.39 | $41.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.82 / $208.96 / $297.49
| Professional | | $149.82 | $208.96 | $297.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.43 / $34.81 / $45.31
| Professional | 26 | $24.43 | $34.81 | $45.31 |