- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $89.13 / $120.23
| Professional | | $70.79 | $89.13 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $251.19
| Facility | | $223.87 | $223.87 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $81.28 / $102.33
| Professional | | $61.66 | $81.28 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $138.04 / $204.17
| Professional | | $91.20 | $138.04 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $109.65 / $141.25
| Professional | | $79.43 | $109.65 | $141.25 |