- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.83 / $22.97 / $92.86
| Professional | | $21.83 | $22.97 | $92.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.80 / $156.34 / $206.10
| Professional | | $43.80 | $156.34 | $206.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.52 / $58.22 / $208.44
| Professional | | $14.52 | $58.22 | $208.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.83 / $64.44 / $141.21
| Facility | | $21.83 | $64.44 | $141.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.09 / $119.49 / $527.54
| Professional | | $68.09 | $119.49 | $527.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.20 / $98.10 / $151.43
| Professional | | $67.20 | $98.10 | $151.43 |