- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.42 / $53.83 / $53.83
| Professional | | $53.42 | $53.83 | $53.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.83 / $30.96 / $30.96
| Professional | 26 | $29.83 | $30.96 | $30.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.35 / $156.35 / $666.17
| Professional | | $156.35 | $156.35 | $666.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.02 / $158.02 / $666.17
| Professional | | $158.02 | $158.02 | $666.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.27 / $28.27 / $115.53
| Professional | 26 | $28.27 | $28.27 | $115.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.79 / $158.02 / $666.17
| Professional | | $67.79 | $158.02 | $666.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.27 / $28.27 / $115.53
| Professional | 26 | $28.27 | $28.27 | $115.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.42 / $142.13 / $817.65
| Professional | | $69.42 | $142.13 | $817.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.11 / $41.99 / $141.80
| Professional | 26 | $29.11 | $41.99 | $141.80 |