- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.89 / $75.20 / $88.16
| Professional | | $73.89 | $75.20 | $88.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.53 / $89.98 / $137.88
| Professional | | $69.53 | $89.98 | $137.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.92 / $20.92 / $20.92
| Facility | 26 | $20.92 | $20.92 | $20.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.84 / $104.86 / $164.69
| Professional | | $75.84 | $104.86 | $164.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.43 / $95.86 / $179.85
| Professional | | $74.43 | $95.86 | $179.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.89 / $79.65 / $97.92
| Professional | | $73.89 | $79.65 | $97.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.70 / $108.32 / $140.93
| Professional | | $67.70 | $108.32 | $140.93 |