- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.56 / $77.65 / $109.19
| Professional | | $73.56 | $77.65 | $109.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.10 / $24.17 / $32.64
| Professional | 26 | $22.10 | $24.17 | $32.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.92 / $95.97 / $268.17
| Professional | | $81.92 | $95.97 | $268.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.68 / $30.19 / $84.40
| Professional | 26 | $24.68 | $30.19 | $84.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.92 / $104.17 / $194.36
| Professional | | $81.92 | $104.17 | $194.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.52 / $31.99 / $84.40
| Professional | 26 | $26.52 | $31.99 | $84.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.05 / $110.96 / $316.72
| Professional | | $74.05 | $110.96 | $316.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.97 / $34.76 / $97.35
| Professional | 26 | $22.97 | $34.76 | $97.35 |