- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $112.20 / $275.42
| Professional | | $79.43 | $112.20 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $213.80 / $245.47
| Facility | | $177.83 | $213.80 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $186.21
| Professional | | $107.15 | $107.15 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $131.83
| Facility | | $112.20 | $112.20 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $83.18 / $112.20
| Professional | | $83.18 | $83.18 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $190.55
| Professional | | $158.49 | $158.49 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $123.03 / $275.42
| Professional | | $87.10 | $123.03 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $104.71 / $114.82
| Facility | | $56.23 | $104.71 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $131.83 / $186.21
| Professional | | $69.18 | $131.83 | $186.21 |