- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.44 / $62.16 / $451.64
| Professional | | $44.44 | $62.16 | $451.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.26 / $48.42 / $54.47
| Professional | | $30.26 | $48.42 | $54.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.21 / $40.46 / $90.53
| Professional | | $33.21 | $40.46 | $90.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $113.52 / $113.52 / $113.52
| Facility | 26 | $113.52 | $113.52 | $113.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.61 / $66.04 / $425.20
| Professional | | $39.61 | $66.04 | $425.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.61 / $46.24 / $89.15
| Professional | | $39.61 | $46.24 | $89.15 |