- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.46 / $73.64 / $74.31
| Professional | | $59.46 | $73.64 | $74.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.95 / $108.02 / $179.38
| Facility | | $57.95 | $108.02 | $179.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.27 / $350.74 / $350.74
| Professional | | $81.27 | $350.74 | $350.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.00 / $101.00 / $101.00
| Facility | | $101.00 | $101.00 | $101.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.27 / $92.00 / $154.46
| Professional | | $81.27 | $92.00 | $154.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.98 / $90.53 / $124.47
| Professional | | $69.98 | $90.53 | $124.47 |