- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $97.72 / $269.15
| Professional | | $79.43 | $97.72 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $117.49 / $117.49
| Professional | | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $83.18 / $158.49
| Professional | | $69.18 | $83.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $123.03 / $204.17
| Professional | | $89.13 | $123.03 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $120.23 / $234.42 / $234.42
| Facility | 26 | $120.23 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $120.23 / $588.84
| Professional | | $83.18 | $120.23 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $102.33 / $181.97
| Professional | | $83.18 | $102.33 | $181.97 |