- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.81 / $95.90 / $128.02
| Professional | | $89.81 | $95.90 | $128.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.69 / $32.47 / $42.08
| Professional | 26 | $31.69 | $32.47 | $42.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.00 / $130.00 / $160.00
| Professional | | $130.00 | $130.00 | $160.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.00 / $45.00 / $56.00
| Professional | 26 | $45.00 | $45.00 | $56.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.89 / $135.69 / $239.13
| Professional | | $93.89 | $135.69 | $239.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.79 / $47.88 / $84.39
| Professional | 26 | $32.79 | $47.88 | $84.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.09 / $149.63 / $297.95
| Professional | | $95.09 | $149.63 | $297.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.96 / $57.01 / $109.73
| Professional | 26 | $30.96 | $57.01 | $109.73 |