- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $60.26 / $407.38
| Professional | | $38.02 | $60.26 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Professional | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $60.26 / $83.18
| Professional | | $56.23 | $60.26 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $44.67 / $131.83
| Professional | | $31.62 | $44.67 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $70.79 / $131.83
| Facility | | $56.23 | $70.79 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $64.57 / $194.98
| Professional | | $37.15 | $64.57 | $194.98 |