- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.95 / $30.28 / $39.96
| Professional | | $17.95 | $30.28 | $39.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.72 / $102.72 / $174.10
| Professional | | $102.72 | $102.72 | $174.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.35 / $40.65 / $70.00
| Professional | | $24.35 | $40.65 | $70.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.21 / $32.40 / $55.70
| Facility | | $19.21 | $32.40 | $55.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.49 / $43.60 / $247.97
| Professional | | $33.49 | $43.60 | $247.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.20 / $42.97 / $51.32
| Professional | | $33.20 | $42.97 | $51.32 |