- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.57 / $168.98 / $185.71
| Professional | | $87.57 | $168.98 | $185.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.64 / $212.64 / $212.64
| Facility | | $212.64 | $212.64 | $212.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.01 / $223.27 / $287.06
| Professional | | $202.01 | $223.27 | $287.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.80 / $101.80 / $307.97
| Professional | | $101.80 | $101.80 | $307.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.22 / $169.63 / $212.64
| Professional | | $128.22 | $169.63 | $212.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.84 / $99.86 / $141.08
| Professional | | $82.84 | $99.86 | $141.08 |