- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.98 / $104.41 / $112.65
| Professional | | $82.98 | $104.41 | $112.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.54 / $362.69 / $429.39
| Facility | | $268.54 | $362.69 | $429.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.54 / $135.93 / $171.76
| Professional | | $115.54 | $135.93 | $171.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.63 / $129.63 / $129.63
| Facility | | $129.63 | $129.63 | $129.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.64 / $94.64 / $134.37
| Professional | | $94.64 | $94.64 | $134.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.50 / $101.52 / $157.91
| Professional | | $73.50 | $101.52 | $157.91 |