- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.60 / $82.25 / $83.30
| Professional | | $60.60 | $82.25 | $83.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.09 / $264.86 / $313.57
| Facility | | $196.09 | $264.86 | $313.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.38 / $78.09 / $125.43
| Professional | | $66.38 | $78.09 | $125.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.23 / $86.66 / $86.66
| Facility | | $80.23 | $86.66 | $86.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.26 / $86.66 / $86.66
| Professional | | $63.26 | $86.66 | $86.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.64 / $74.14 / $115.32
| Professional | | $58.64 | $74.14 | $115.32 |