- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.45 / $98.10 / $157.55
| Professional | | $72.45 | $98.10 | $157.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.38 / $148.38 / $212.98
| Professional | | $148.38 | $148.38 | $212.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.47 / $141.49 / $211.01
| Professional | | $101.47 | $141.49 | $211.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.45 / $103.64 / $168.58
| Facility | | $72.45 | $103.64 | $168.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.51 / $137.16 / $595.01
| Professional | | $104.51 | $137.16 | $595.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.51 / $135.91 / $162.34
| Professional | | $104.51 | $135.91 | $162.34 |