- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.58 / $48.09 / $59.08
| Professional | | $41.58 | $48.09 | $59.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.82 / $51.82 / $51.82
| Professional | | $51.82 | $51.82 | $51.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.65 / $25.65 / $25.65
| Professional | | $25.65 | $25.65 | $25.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.08 / $51.33 / $74.28
| Facility | | $46.08 | $51.33 | $74.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.64 / $30.97 / $354.83
| Professional | | $20.64 | $30.97 | $354.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.77 / $28.64 / $39.65
| Professional | | $17.77 | $28.64 | $39.65 |