- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.19 / $157.26 / $216.01
| Professional | | $129.19 | $157.26 | $216.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.15 / $184.29 / $297.45
| Professional | | $125.15 | $184.29 | $297.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.63 / $119.46 / $159.52
| Facility | | $85.63 | $119.46 | $159.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.62 / $183.95 / $293.82
| Professional | | $178.62 | $183.95 | $293.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.37 / $172.81 / $302.68
| Professional | | $137.37 | $172.81 | $302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.48 / $185.82 / $312.87
| Professional | | $78.48 | $185.82 | $312.87 |