- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $114.82 / $120.23
| Professional | | $72.44 | $114.82 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $158.49 / $173.78
| Professional | | $117.49 | $158.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $173.78 / $208.93
| Professional | | $165.96 | $173.78 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $117.49 / $204.17
| Facility | | $117.49 | $117.49 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $57.54 / $707.95
| Professional | | $40.74 | $57.54 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $114.82
| Professional | | $47.86 | $47.86 | $114.82 |