- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.52 / $154.72 / $164.40
| Professional | | $131.52 | $154.72 | $164.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.83 / $20.03 / $127.94
| Facility | | $13.83 | $20.03 | $127.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.90 / $17.53 / $137.78
| Professional | | $14.90 | $17.53 | $137.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.77 / $153.77 / $236.75
| Facility | | $153.77 | $153.77 | $236.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.44 / $153.77 / $990.03
| Professional | | $18.44 | $153.77 | $990.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.27 / $101.93 / $210.73
| Professional | | $77.27 | $101.93 | $210.73 |