- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.29 / $168.33 / $336.66
| Professional | | $94.29 | $168.33 | $336.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.95 / $134.31 / $151.10
| Professional | | $83.95 | $134.31 | $151.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.48 / $140.41 / $221.31
| Professional | | $74.48 | $140.41 | $221.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.72 / $174.51 / $281.45
| Facility | | $103.72 | $174.51 | $281.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.44 / $140.72 / $1,157.24
| Professional | | $84.44 | $140.72 | $1,157.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.44 / $119.62 / $185.86
| Professional | | $84.44 | $119.62 | $185.86 |