- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.41 / $97.49 / $149.11
| Professional | | $95.41 | $97.49 | $149.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.69 / $34.57 / $48.46
| Professional | 26 | $31.69 | $34.57 | $48.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.78 / $118.77 / $183.85
| Professional | | $91.78 | $118.77 | $183.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.18 / $42.94 / $63.80
| Professional | 26 | $33.18 | $42.94 | $63.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.04 / $36.04 / $36.04
| Facility | 26 | $36.04 | $36.04 | $36.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.34 / $132.72 / $205.25
| Professional | | $96.34 | $132.72 | $205.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.93 / $46.17 / $72.81
| Professional | 26 | $34.93 | $46.17 | $72.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.24 / $127.81 / $239.81
| Professional | | $99.24 | $127.81 | $239.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.44 / $44.35 / $88.41
| Professional | 26 | $34.44 | $44.35 | $88.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.15 / $97.49 / $156.94
| Professional | | $94.15 | $97.49 | $156.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.69 / $34.95 / $47.91
| Professional | 26 | $31.69 | $34.95 | $47.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.56 / $129.84 / $181.95
| Professional | | $86.56 | $129.84 | $181.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.20 / $47.82 / $63.10
| Professional | 26 | $33.20 | $47.82 | $63.10 |