- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.94 / $48.61 / $77.37
| Professional | | $28.94 | $48.61 | $77.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.15 / $54.03 / $85.64
| Professional | | $31.15 | $54.03 | $85.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.40 / $66.33 / $106.82
| Professional | | $46.40 | $66.33 | $106.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.28 / $68.59 / $115.13
| Professional | | $40.28 | $68.59 | $115.13 |