- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.69 / $59.97 / $102.55
| Professional | | $53.69 | $59.97 | $102.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.08 / $139.08 / $139.08
| Facility | | $139.08 | $139.08 | $139.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.53 / $101.53 / $101.53
| Professional | | $101.53 | $101.53 | $101.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.39 / $130.71 / $181.59
| Professional | | $106.39 | $130.71 | $181.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.48 / $89.63 / $143.15
| Professional | | $64.48 | $89.63 | $143.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.47 / $162.57 / $162.57
| Professional | | $82.47 | $162.57 | $162.57 |