- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.48 / $100.40 / $128.03
| Professional | | $70.48 | $100.40 | $128.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.88 / $219.85 / $258.44
| Professional | | $175.88 | $219.85 | $258.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.44 / $84.68 / $91.20
| Facility | | $66.44 | $84.68 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.06 / $107.54 / $148.51
| Professional | | $87.06 | $107.54 | $148.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.01 / $125.92 / $243.25
| Professional | | $78.01 | $125.92 | $243.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.45 / $136.85 / $232.28
| Professional | | $106.45 | $136.85 | $232.28 |