- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.62 / $84.81 / $135.75
| Professional | | $56.62 | $84.81 | $135.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.23 / $427.23 / $528.92
| Facility | | $427.23 | $427.23 | $528.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.77 / $122.27 / $305.14
| Professional | | $74.77 | $122.27 | $305.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.70 / $123.96 / $305.14
| Professional | | $80.70 | $123.96 | $305.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.90 / $108.73 / $340.20
| Professional | | $84.90 | $108.73 | $340.20 |