- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.84 / $82.68 / $131.40
| Professional | | $62.84 | $82.68 | $131.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.47 / $114.86 / $135.13
| Professional | | $111.47 | $114.86 | $135.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.75 / $111.47 / $135.13
| Facility | | $94.75 | $111.47 | $135.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.03 / $114.43 / $161.83
| Professional | | $73.03 | $114.43 | $161.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.37 / $93.62 / $160.66
| Facility | | $61.37 | $93.62 | $160.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.90 / $138.57 / $207.40
| Professional | | $83.90 | $138.57 | $207.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.77 / $142.80 / $164.51
| Professional | | $119.77 | $142.80 | $164.51 |