- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.56 / $116.94 / $189.16
| Professional | | $75.56 | $116.94 | $189.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.04 / $83.04 / $127.75
| Professional | | $83.04 | $83.04 | $127.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.48 / $121.21 / $220.56
| Professional | | $81.48 | $121.21 | $220.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.56 / $111.27 / $162.34
| Facility | | $75.56 | $111.27 | $162.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.04 / $175.43 / $839.44
| Professional | | $114.04 | $175.43 | $839.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.04 / $125.44 / $237.73
| Professional | | $114.04 | $125.44 | $237.73 |