- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.96 / $33.29 / $40.69
| Professional | | $23.96 | $33.29 | $40.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.97 / $36.97 / $56.52
| Professional | | $25.97 | $36.97 | $56.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $159.22 / $211.61
| Facility | | $80.00 | $159.22 | $211.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.02 / $244.02 / $340.28
| Professional | | $244.02 | $244.02 | $340.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.30 / $38.18 / $64.23
| Professional | | $30.30 | $38.18 | $64.23 |