- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.70 / $150.52 / $193.08
| Professional | | $117.70 | $150.52 | $193.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.45 / $147.26 / $242.48
| Professional | | $114.45 | $147.26 | $242.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.97 / $203.78 / $324.26
| Professional | | $133.97 | $203.78 | $324.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.09 / $165.18 / $292.50
| Facility | | $116.09 | $165.18 | $292.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.27 / $331.89 / $1,041.92
| Professional | | $152.27 | $331.89 | $1,041.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.79 / $208.58 / $362.83
| Professional | | $137.79 | $208.58 | $362.83 |