- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $12.02 / $60.26
| Professional | | $10.00 | $12.02 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $51.29 / $83.18
| Professional | | $10.00 | $51.29 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $21.88 / $331.13
| Facility | | $12.30 | $21.88 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $61.66 / $83.18
| Professional | | $10.47 | $61.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $46.77 / $138.04
| Professional | | $13.18 | $46.77 | $138.04 |