- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $120.23 / $218.78
| Professional | | $97.72 | $120.23 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $158.49 / $245.47
| Professional | | $91.20 | $158.49 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $457.09
| Facility | | $177.83 | $177.83 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $165.96 / $251.19
| Professional | | $114.82 | $165.96 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $173.78 / $288.40
| Professional | | $109.65 | $173.78 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $154.88 / $331.13
| Professional | | $102.33 | $154.88 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $151.36 / $245.47
| Professional | | $107.15 | $151.36 | $245.47 |