- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.28 / $48.89 / $58.58
| Professional | | $45.28 | $48.89 | $58.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $208.65 / $208.65
| Facility | | $100.00 | $208.65 | $208.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.36 / $201.25 / $238.32
| Professional | | $185.36 | $201.25 | $238.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.40 / $64.59 / $97.40
| Professional | | $27.40 | $64.59 | $97.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.13 / $55.16 / $55.16
| Facility | | $44.13 | $55.16 | $55.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.96 / $55.16 / $55.16
| Professional | | $52.96 | $55.16 | $55.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.45 / $48.18 / $52.96
| Professional | | $45.45 | $48.18 | $52.96 |