- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.58 / $76.45 / $80.86
| Professional | | $59.58 | $76.45 | $80.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.79 / $260.41 / $308.29
| Facility | | $192.79 | $260.41 | $308.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.69 / $89.05 / $123.32
| Professional | | $75.69 | $89.05 | $123.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.86 / $104.21 / $104.21
| Facility | | $78.86 | $104.21 | $104.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.06 / $76.06 / $76.06
| Professional | | $76.06 | $76.06 | $76.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.27 / $68.03 / $113.39
| Professional | | $53.27 | $68.03 | $113.39 |