- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.86 / $61.28 / $76.59
| Professional | | $52.86 | $61.28 | $76.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.68 / $61.64 / $1,974.91
| Facility | | $45.68 | $61.64 | $1,974.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.00 / $582.00 / $582.00
| Professional | | $53.00 | $582.00 | $582.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.60 / $53.72 / $61.00
| Facility | | $32.60 | $53.72 | $61.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.63 / $59.06 / $62.33
| Professional | | $33.63 | $59.06 | $62.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.40 / $85.40 / $85.40
| Professional | | $85.40 | $85.40 | $85.40 |