- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $123.03 / $177.83
| Professional | | $75.86 | $123.03 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $549.54 / $549.54
| Facility | | $436.52 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $151.36 / $269.15
| Professional | | $83.18 | $151.36 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $186.21 / $331.13
| Professional | | $134.90 | $186.21 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $158.49 / $295.12
| Professional | | $125.89 | $158.49 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $134.90 / $389.05
| Professional | | $97.72 | $134.90 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $151.36 / $295.12
| Professional | | $114.82 | $151.36 | $295.12 |