- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.62 / $33.70 / $105.62
| Professional | | $29.62 | $33.70 | $105.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.58 / $42.58 / $42.58
| Professional | | $42.58 | $42.58 | $42.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.67 / $33.47 / $39.67
| Facility | | $32.67 | $33.47 | $39.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.13 / $21.13 / $32.67
| Professional | | $21.13 | $21.13 | $32.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.28 / $46.18 / $110.36
| Professional | | $32.28 | $46.18 | $110.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.17 / $39.53 / $79.20
| Professional | | $22.17 | $39.53 | $79.20 |