- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.58 / $73.84 / $440.78
| Professional | | $41.58 | $73.84 | $440.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.74 / $114.74 / $114.74
| Facility | | $114.74 | $114.74 | $114.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.75 / $89.73 / $154.07
| Professional | | $81.75 | $89.73 | $154.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.74 / $114.74 / $114.74
| Facility | | $114.74 | $114.74 | $114.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.56 / $89.73 / $154.07
| Professional | | $44.56 | $89.73 | $154.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.94 / $83.37 / $158.38
| Professional | | $29.94 | $83.37 | $158.38 |