- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.29 / $56.22 / $63.72
| Professional | | $33.29 | $56.22 | $63.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.06 / $110.75 / $110.75
| Professional | | $59.06 | $110.75 | $110.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.68 / $33.68 / $86.36
| Professional | | $33.68 | $33.68 | $86.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.45 / $72.47 / $120.00
| Professional | | $56.45 | $72.47 | $120.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.41 / $103.36 / $2,500.00
| Professional | | $100.41 | $103.36 | $2,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.41 / $36.83 / $49.56
| Professional | | $27.41 | $36.83 | $49.56 |