- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.90 / $127.88 / $137.97
| Professional | | $74.90 | $127.88 | $137.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.69 / $545.17 / $894.76
| Facility | | $394.69 | $545.17 | $894.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.67 / $148.16 / $205.38
| Professional | | $103.67 | $148.16 | $205.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.63 / $190.07 / $277.43
| Professional | | $135.63 | $190.07 | $277.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.08 / $157.72 / $284.55
| Professional | | $131.08 | $157.72 | $284.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.90 / $127.88 / $177.69
| Professional | | $74.90 | $127.88 | $177.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.13 / $137.30 / $284.31
| Professional | | $115.13 | $137.30 | $284.31 |