- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.78 / $75.29 / $86.19
| Professional | | $45.78 | $75.29 | $86.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.64 / $308.64 / $308.64
| Facility | | $308.64 | $308.64 | $308.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.16 / $131.22 / $131.22
| Professional | | $128.16 | $131.22 | $131.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.24 / $47.24 / $47.24
| Professional | | $47.24 | $47.24 | $47.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.02 / $107.02 / $107.02
| Professional | | $107.02 | $107.02 | $107.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.78 / $75.29 / $86.19
| Professional | | $45.78 | $75.29 | $86.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $65.47 / $150.57
| Professional | | $43.65 | $65.47 | $150.57 |