- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $40.74 / $97.72
| Professional | | $25.70 | $40.74 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $39.81 / $72.44
| Professional | | $24.55 | $39.81 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $56.23 / $91.20
| Professional | | $33.88 | $56.23 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,412.54 / $6,456.54
| Facility | | $338.84 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $48.98 / $83.18
| Professional | | $30.20 | $48.98 | $83.18 |