- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $562.34
| Professional | | $30.20 | $47.86 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $38.90 / $52.48
| Facility | | $32.36 | $38.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Professional | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $436.52 / $794.33
| Professional | | $239.88 | $436.52 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $50.12 / $70.79
| Professional | | $43.65 | $50.12 | $70.79 |