- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.69 / $88.72 / $90.86
| Professional | | $80.69 | $88.72 | $90.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.31 / $37.85 / $39.82
| Professional | 26 | $35.31 | $37.85 | $39.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.00 / $149.00 / $149.00
| Professional | | $120.00 | $149.00 | $149.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.00 / $65.00 / $65.00
| Professional | 26 | $52.00 | $65.00 | $65.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.05 / $130.40 / $173.08
| Professional | | $91.05 | $130.40 | $173.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.59 / $56.79 / $77.70
| Professional | 26 | $42.59 | $56.79 | $77.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.15 / $147.63 / $277.18
| Professional | | $104.15 | $147.63 | $277.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.58 / $72.89 / $124.74
| Professional | 26 | $49.58 | $72.89 | $124.74 |