- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.38 / $92.40 / $280.57
| Professional | | $57.38 | $92.40 | $280.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.08 / $83.08 / $83.08
| Facility | | $83.08 | $83.08 | $83.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.08 / $89.63 / $135.66
| Professional | | $83.08 | $89.63 | $135.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.66 / $151.44 / $157.49
| Facility | | $51.66 | $151.44 | $157.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.98 / $87.63 / $135.66
| Professional | | $53.98 | $87.63 | $135.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.82 / $138.61 / $234.94
| Professional | | $118.82 | $138.61 | $234.94 |