- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.10 / $25.02 / $139.91
| Professional | | $11.10 | $25.02 | $139.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.64 / $64.30 / $124.03
| Facility | | $32.64 | $64.30 | $124.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.17 / $24.78 / $30.98
| Professional | | $8.17 | $24.78 | $30.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.64 / $64.30 / $124.03
| Facility | | $32.64 | $64.30 | $124.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.57 / $19.57 / $27.20
| Professional | | $19.57 | $19.57 | $27.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.86 / $9.14 / $21.76
| Professional | | $6.86 | $9.14 | $21.76 |