- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.59 / $87.93 / $118.20
| Professional | | $63.59 | $87.93 | $118.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.15 / $129.28 / $169.17
| Professional | | $94.15 | $129.28 | $169.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.21 / $116.60 / $168.20
| Professional | | $85.21 | $116.60 | $168.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.33 / $107.86 / $153.34
| Facility | | $81.33 | $107.86 | $153.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.51 / $128.36 / $595.01
| Professional | | $104.51 | $128.36 | $595.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.60 / $122.26 / $156.77
| Professional | | $103.60 | $122.26 | $156.77 |