- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.65 / $44.52 / $56.67
| Professional | | $36.65 | $44.52 | $56.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.88 / $58.68 / $86.30
| Professional | | $49.88 | $58.68 | $86.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.53 / $73.88 / $104.43
| Professional | | $33.53 | $73.88 | $104.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,183.00 / $4,915.00
| Facility | | $540.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.02 / $63.52 / $92.03
| Professional | | $47.02 | $63.52 | $92.03 |