- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.43 / $79.40 / $451.08
| Professional | | $76.43 | $79.40 | $451.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.72 / $133.25 / $401.74
| Facility | | $105.72 | $133.25 | $401.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.31 / $107.79 / $210.26
| Professional | | $69.31 | $107.79 | $210.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.72 / $133.25 / $401.74
| Facility | | $105.72 | $133.25 | $401.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.23 / $98.08 / $129.19
| Professional | | $69.23 | $98.08 | $129.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.12 / $67.56 / $137.53
| Professional | | $61.12 | $67.56 | $137.53 |