- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.35 / $83.04 / $113.31
| Professional | | $59.35 | $83.04 | $113.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.75 / $475.75 / $609.26
| Facility | | $475.75 | $475.75 | $609.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.44 / $113.68 / $273.36
| Professional | | $96.44 | $113.68 | $273.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.61 / $113.16 / $171.67
| Professional | | $71.61 | $113.16 | $171.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.38 / $110.32 / $171.67
| Professional | | $78.38 | $110.32 | $171.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.07 / $120.45 / $313.45
| Professional | | $106.07 | $120.45 | $313.45 |