- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $38.61 / $104.40
| Professional | | $27.00 | $38.61 | $104.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.53 / $73.56 / $86.68
| Professional | | $62.53 | $73.56 | $86.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.43 / $71.51 / $106.54
| Professional | | $38.43 | $71.51 | $106.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.90 / $40.84 / $61.00
| Facility | | $29.90 | $40.84 | $61.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.81 / $49.01 / $212.11
| Professional | | $34.81 | $49.01 | $212.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.81 / $43.00 / $81.90
| Professional | | $34.81 | $43.00 | $81.90 |