- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.90 / $105.17 / $177.91
| Professional | | $95.90 | $105.17 | $177.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.69 / $37.95 / $73.90
| Professional | 26 | $31.69 | $37.95 | $73.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.45 / $112.50 / $320.62
| Professional | | $95.45 | $112.50 | $320.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.78 / $128.01 / $322.63
| Professional | | $105.78 | $128.01 | $322.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.45 / $44.67 / $114.90
| Professional | 26 | $36.45 | $44.67 | $114.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.78 / $135.04 / $320.62
| Professional | | $105.78 | $135.04 | $320.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.90 / $47.14 / $114.90
| Professional | 26 | $36.90 | $47.14 | $114.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.45 / $138.69 / $378.05
| Professional | | $88.45 | $138.69 | $378.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.58 / $49.26 / $137.97
| Professional | 26 | $32.58 | $49.26 | $137.97 |