- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.84 / $107.30 / $167.43
| Professional | | $85.84 | $107.30 | $167.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.00 / $142.56 / $438.06
| Facility | | $74.00 | $142.56 | $438.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.42 / $1,070.79 / $1,070.79
| Professional | | $71.42 | $1,070.79 | $1,070.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.18 / $64.28 / $74.00
| Facility | | $51.18 | $64.28 | $74.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.59 / $71.00 / $83.16
| Professional | | $47.59 | $71.00 | $83.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.00 / $120.00 / $120.00
| Professional | | $120.00 | $120.00 | $120.00 |