- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.01 / $103.74 / $127.54
| Professional | | $73.01 | $103.74 | $127.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.16 / $432.57 / $709.94
| Facility | | $313.16 | $432.57 | $709.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.05 / $152.75 / $220.64
| Professional | | $111.05 | $152.75 | $220.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.86 / $159.02 / $270.19
| Professional | | $102.86 | $159.02 | $270.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.74 / $170.48 / $322.31
| Professional | | $139.74 | $170.48 | $322.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.76 / $125.29 / $186.72
| Professional | | $74.76 | $125.29 | $186.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.74 / $133.16 / $265.50
| Professional | | $104.74 | $133.16 | $265.50 |