- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.73 / $118.74 / $152.40
| Professional | | $112.73 | $118.74 | $152.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.26 / $210.42 / $398.77
| Professional | | $105.26 | $210.42 | $398.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.41 / $101.94 / $351.15
| Facility | | $95.41 | $101.94 | $351.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.45 / $109.11 / $341.18
| Professional | | $68.45 | $109.11 | $341.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.52 / $713.93 / $713.93
| Facility | | $261.52 | $713.93 | $713.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.25 / $1,210.74 / $1,210.74
| Professional | | $1,127.25 | $1,210.74 | $1,210.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.18 / $150.30 / $330.66
| Professional | | $90.18 | $150.30 | $330.66 |