- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.75 / $90.43 / $143.34
| Professional | | $59.75 | $90.43 | $143.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.11 / $82.82 / $103.52
| Professional | | $62.11 | $82.82 | $103.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.16 / $22.16 / $22.16
| Facility | 26 | $22.16 | $22.16 | $22.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.99 / $94.38 / $200.65
| Professional | | $47.99 | $94.38 | $200.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.71 / $122.36 / $122.36
| Facility | 26 | $44.71 | $122.36 | $122.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.16 / $89.60 / $641.64
| Professional | | $42.16 | $89.60 | $641.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.16 / $84.16 / $170.41
| Professional | | $42.16 | $84.16 | $170.41 |