- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.84 / $121.42 / $157.85
| Professional | | $98.84 | $121.42 | $157.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.52 / $147.52 / $221.28
| Professional | | $147.52 | $147.52 | $221.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.86 / $121.84 / $322.00
| Professional | | $77.86 | $121.84 | $322.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.25 / $177.02 / $278.26
| Facility | | $110.25 | $177.02 | $278.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.52 / $206.53 / $544.35
| Professional | | $147.52 | $206.53 | $544.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.51 / $125.39 / $341.57
| Professional | | $88.51 | $125.39 | $341.57 |