- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.01 / $68.02 / $380.77
| Professional | | $50.01 | $68.02 | $380.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.64 / $131.82 / $153.50
| Facility | | $118.64 | $131.82 | $153.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.33 / $74.50 / $130.60
| Professional | | $63.33 | $74.50 | $130.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.56 / $101.56 / $101.56
| Facility | | $101.56 | $101.56 | $101.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.19 / $91.45 / $128.09
| Professional | | $61.19 | $91.45 | $128.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.23 / $79.88 / $115.88
| Professional | | $64.23 | $79.88 | $115.88 |