- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $112.20 / $208.93
| Professional | | $91.20 | $112.20 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $144.54 / $204.17
| Professional | | $120.23 | $144.54 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $141.25 / $512.86
| Professional | | $64.57 | $141.25 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $158.49 / $426.58
| Facility | | $104.71 | $158.49 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $131.83 / $758.58
| Professional | | $79.43 | $131.83 | $758.58 |