- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.32 / $52.84 / $66.87
| Professional | | $34.32 | $52.84 | $66.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.25 / $131.00 / $307.85
| Professional | | $98.25 | $131.00 | $307.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.31 / $73.31 / $73.31
| Professional | | $73.31 | $73.31 | $73.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.38 / $885.11 / $885.11
| Facility | | $101.38 | $885.11 | $885.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.45 / $367.45 / $479.40
| Professional | | $367.45 | $367.45 | $479.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $70.00
| Professional | | $30.00 | $30.00 | $70.00 |