- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.00 / $101.02 / $117.40
| Professional | | $16.00 | $101.02 | $117.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.50 / $14.56 / $107.43
| Professional | | $8.50 | $14.56 | $107.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.25 / $13.40 / $182.44
| Professional | | $10.25 | $13.40 | $182.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.34 / $15.51 / $112.92
| Facility | | $10.34 | $15.51 | $112.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.00 / $329.00 / $329.00
| Professional | | $329.00 | $329.00 | $329.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.80 / $155.62 / $376.55
| Professional | | $107.80 | $155.62 | $376.55 |