- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.34 / $107.72 / $137.35
| Professional | | $92.34 | $107.72 | $137.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.16 / $471.05 / $825.40
| Facility | | $126.16 | $471.05 | $825.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.52 / $98.59 / $122.61
| Professional | | $69.52 | $98.59 | $122.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.43 / $107.43 / $107.43
| Professional | | $107.43 | $107.43 | $107.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.34 / $110.18 / $197.89
| Facility | | $92.34 | $110.18 | $197.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.77 / $146.80 / $768.84
| Professional | | $113.77 | $146.80 | $768.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.77 / $132.12 / $240.87
| Professional | | $113.77 | $132.12 | $240.87 |