- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $67.61 / $81.28
| Professional | | $41.69 | $67.61 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $72.44 / $81.28
| Professional | | $57.54 | $72.44 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $63.10 / $131.83
| Professional | | $31.62 | $63.10 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $72.44 / $100.00
| Facility | | $30.20 | $72.44 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $57.54 / $436.52
| Professional | | $32.36 | $57.54 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $50.12 / $83.18
| Professional | | $30.20 | $50.12 | $83.18 |