- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.24 / $145.56 / $190.01
| Professional | | $111.24 | $145.56 | $190.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.98 / $138.33 / $184.59
| Professional | | $100.98 | $138.33 | $184.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.92 / $170.36 / $255.54
| Professional | | $108.92 | $170.36 | $255.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.50 / $136.87 / $204.02
| Professional | | $1.50 | $136.87 | $204.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.57 / $177.57 / $177.57
| Facility | | $177.57 | $177.57 | $177.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.86 / $116.34 / $154.83
| Professional | | $113.86 | $116.34 | $154.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.69 / $177.60 / $326.39
| Professional | | $150.69 | $177.60 | $326.39 |