- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.64 / $52.92 / $86.55
| Professional | | $43.64 | $52.92 | $86.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.65 / $78.65 / $78.65
| Professional | | $78.65 | $78.65 | $78.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.13 / $43.79 / $49.81
| Professional | | $36.13 | $43.79 | $49.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.13 / $72.77 / $117.40
| Professional | | $46.13 | $72.77 | $117.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.96 / $169.20 / $169.20
| Facility | 26 | $24.96 | $169.20 | $169.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.19 / $73.08 / $619.00
| Professional | | $46.19 | $73.08 | $619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.11 / $60.90 / $102.39
| Professional | | $46.11 | $60.90 | $102.39 |