- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.41 / $150.10 / $173.19
| Professional | | $88.41 | $150.10 | $173.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.84 / $248.84 / $248.84
| Professional | | $248.84 | $248.84 | $248.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.81 / $175.81 / $226.06
| Facility | | $175.81 | $175.81 | $226.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.34 / $165.76 / $191.33
| Professional | | $128.34 | $165.76 | $191.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.81 / $175.81 / $226.06
| Facility | | $175.81 | $175.81 | $226.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.34 / $175.81 / $191.33
| Professional | | $128.34 | $175.81 | $191.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.39 / $182.20 / $355.58
| Professional | | $106.39 | $182.20 | $355.58 |