- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $77.62 / $257.04
| Professional | | $60.26 | $77.62 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $208.93 / $251.19
| Professional | | $186.21 | $208.93 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $125.89 / $158.49
| Professional | | $104.71 | $125.89 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $66.07 / $102.33
| Facility | | $51.29 | $66.07 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $223.87 / $602.56
| Professional | | $204.17 | $223.87 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $177.83 / $223.87
| Professional | | $87.10 | $177.83 | $223.87 |