- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.48 / $74.76 / $93.25
| Professional | | $61.48 | $74.76 | $93.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.55 / $150.06 / $184.29
| Professional | | $127.55 | $150.06 | $184.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.51 / $142.16 / $213.08
| Professional | | $92.51 | $142.16 | $213.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.08 / $73.03 / $104.57
| Facility | | $42.08 | $73.03 | $104.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.50 / $104.12 / $439.61
| Professional | | $46.50 | $104.12 | $439.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.50 / $86.00 / $174.90
| Professional | | $46.50 | $86.00 | $174.90 |