- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.42 / $52.46 / $532.00
| Professional | | $38.42 | $52.46 | $532.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.96 / $56.38 / $64.84
| Professional | | $28.96 | $56.38 | $64.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.38 / $56.66 / $235.64
| Professional | | $56.38 | $56.66 | $235.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.04 / $44.34 / $191.25
| Professional | | $32.04 | $44.34 | $191.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.68 / $102.11 / $115.18
| Facility | | $56.68 | $102.11 | $115.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.59 / $62.29 / $93.18
| Professional | | $52.59 | $62.29 | $93.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.00 / $53.36 / $182.52
| Professional | | $37.00 | $53.36 | $182.52 |