- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.81 / $86.77 / $92.15
| Professional | | $62.81 | $86.77 | $92.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.36 / $314.05 / $515.41
| Facility | | $227.36 | $314.05 | $515.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.56 / $109.17 / $157.68
| Professional | | $79.56 | $109.17 | $157.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.08 / $125.94 / $202.57
| Professional | | $102.08 | $125.94 | $202.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.58 / $120.50 / $218.34
| Professional | | $100.58 | $120.50 | $218.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.44 / $89.13 / $135.49
| Professional | | $63.44 | $89.13 | $135.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.65 / $121.65 / $204.88
| Professional | | $82.65 | $121.65 | $204.88 |