- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.34 / $104.21 / $219.30
| Professional | | $71.34 | $104.21 | $219.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.59 / $93.66 / $148.65
| Professional | | $82.59 | $93.66 | $148.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.84 / $110.52 / $206.73
| Professional | | $72.84 | $110.52 | $206.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.01 / $105.42 / $161.16
| Facility | | $68.01 | $105.42 | $161.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.64 / $153.68 / $839.44
| Professional | | $104.64 | $153.68 | $839.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.37 / $114.04 / $219.92
| Professional | | $101.37 | $114.04 | $219.92 |