- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.79 / $153.59 / $154.65
| Professional | | $112.79 | $153.59 | $154.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.30 / $27.21 / $28.18
| Professional | 26 | $22.30 | $27.21 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.93 / $213.54 / $543.86
| Professional | | $161.93 | $213.54 | $543.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.71 / $33.60 / $82.93
| Professional | 26 | $24.71 | $33.60 | $82.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.93 / $213.54 / $543.86
| Professional | | $161.93 | $213.54 | $543.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.71 / $33.60 / $82.93
| Professional | 26 | $24.71 | $33.60 | $82.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.50 / $222.52 / $640.15
| Professional | | $157.50 | $222.52 | $640.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.43 / $34.88 / $99.51
| Professional | 26 | $24.43 | $34.88 | $99.51 |