- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.70 / $143.75 / $154.16
| Professional | | $72.70 | $143.75 | $154.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.27 / $90.19 / $234.75
| Professional | | $64.27 | $90.19 | $234.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.51 / $84.51 / $84.51
| Professional | | $84.51 | $84.51 | $84.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.70 / $153.41 / $227.47
| Facility | | $122.70 | $153.41 | $227.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.06 / $231.26 / $387.33
| Professional | | $176.06 | $231.26 | $387.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.39 / $87.83 / $126.01
| Professional | | $79.39 | $87.83 | $126.01 |