- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.56 / $147.52 / $785.20
| Professional | | $111.56 | $147.52 | $785.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.53 / $111.42 / $309.80
| Facility | | $81.53 | $111.42 | $309.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.72 / $205.06 / $314.68
| Professional | | $174.72 | $205.06 | $314.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.53 / $160.60 / $309.80
| Facility | | $81.53 | $160.60 | $309.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.11 / $181.49 / $241.08
| Professional | | $128.11 | $181.49 | $241.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.41 / $144.47 / $244.65
| Professional | | $118.41 | $144.47 | $244.65 |