- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $117.49 / $223.87
| Professional | | $81.28 | $117.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $125.89 / $229.09
| Professional | | $75.86 | $125.89 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $691.83
| Facility | | $134.90 | $134.90 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $144.54 / $281.84
| Professional | | $89.13 | $144.54 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $154.88 / $275.42
| Professional | | $87.10 | $154.88 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $144.54 / $309.03
| Professional | | $85.11 | $144.54 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $134.90 / $229.09
| Professional | | $87.10 | $134.90 | $229.09 |