- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.57 / $157.82 / $220.37
| Professional | | $87.57 | $157.82 | $220.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.23 / $74.23 / $81.66
| Facility | | $74.23 | $74.23 | $81.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.25 / $207.25 / $247.46
| Professional | | $207.25 | $207.25 | $247.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.80 / $101.80 / $101.80
| Professional | | $101.80 | $101.80 | $101.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.39 / $207.85 / $311.06
| Facility | | $127.39 | $207.85 | $311.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.82 / $105.81 / $1,614.29
| Professional | | $97.82 | $105.81 | $1,614.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.82 / $105.81 / $151.79
| Professional | | $97.82 | $105.81 | $151.79 |