- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.00 / $79.23 / $92.30
| Professional | | $68.00 | $79.23 | $92.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.06 / $297.19 / $351.83
| Facility | | $220.06 | $297.19 | $351.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.40 / $101.65 / $140.72
| Professional | | $86.40 | $101.65 | $140.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.03 / $103.32 / $103.32
| Facility | | $90.03 | $103.32 | $103.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.42 / $103.32 / $103.32
| Professional | | $75.42 | $103.32 | $103.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.76 / $77.64 / $129.40
| Professional | | $59.76 | $77.64 | $129.40 |