- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $645.65
| Professional | | $30.20 | $47.86 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $38.90 / $52.48
| Facility | | $33.11 | $38.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $457.09
| Professional | | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $389.05 / $549.54
| Professional | | $281.84 | $389.05 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $50.12 / $70.79
| Professional | | $43.65 | $50.12 | $70.79 |