- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $114.82 / $275.42
| Professional | | $85.11 | $114.82 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $363.08 / $416.87
| Facility | | $263.03 | $363.08 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $102.33 / $194.98
| Professional | | $75.86 | $102.33 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $112.20
| Facility | | $104.71 | $104.71 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $83.18 / $112.20
| Professional | | $83.18 | $83.18 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $134.90 / $239.88
| Facility | | $114.82 | $134.90 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $112.20 / $151.36
| Professional | | $85.11 | $112.20 | $151.36 |