- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.48 / $100.27 / $107.43
| Professional | | $74.48 | $100.27 | $107.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.93 / $218.49 / $254.15
| Facility | | $159.93 | $218.49 | $254.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.07 / $134.00 / $214.13
| Professional | | $119.07 | $134.00 | $214.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.44 / $326.44 / $573.86
| Facility | | $326.44 | $326.44 | $573.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.30 / $161.86 / $218.39
| Professional | | $92.30 | $161.86 | $218.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.45 / $130.88 / $240.35
| Professional | | $67.45 | $130.88 | $240.35 |