- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.36 / $66.41 / $91.29
| Professional | | $55.36 | $66.41 | $91.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.55 / $358.67 / $424.62
| Facility | | $265.55 | $358.67 | $424.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.63 / $126.62 / $169.85
| Professional | | $107.63 | $126.62 | $169.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.42 / $107.42 / $153.94
| Facility | | $107.42 | $107.42 | $153.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.42 / $107.42 / $153.94
| Professional | | $78.42 | $107.42 | $153.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.00 / $85.00 / $85.00
| Facility | | $85.00 | $85.00 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.37 / $100.06 / $156.16
| Professional | | $73.37 | $100.06 | $156.16 |