- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.23 / $74.47 / $93.08
| Professional | | $64.23 | $74.47 | $93.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.76 / $75.92 / $1,974.91
| Facility | | $55.76 | $75.92 | $1,974.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.00 / $236.59 / $236.59
| Professional | | $63.00 | $236.59 | $236.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.74 / $65.48 / $73.00
| Facility | | $39.74 | $65.48 | $73.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.87 / $70.20 / $75.73
| Professional | | $41.87 | $70.20 | $75.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.10 / $106.10 / $106.10
| Professional | | $106.10 | $106.10 | $106.10 |