- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $36.31 / $45.71
| Professional | | $34.67 | $36.31 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $61.66 / $398.11
| Professional | | $21.88 | $61.66 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Facility | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Professional | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $14.79 / $16.60
| Facility | | $10.47 | $14.79 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $40.74 / $123.03
| Professional | | $12.59 | $40.74 | $123.03 |