- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.39 / $140.28 / $147.47
| Professional | | $79.39 | $140.28 | $147.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.06 / $176.06 / $176.06
| Facility | | $176.06 | $176.06 | $176.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.26 / $184.86 / $237.68
| Professional | | $167.26 | $184.86 | $237.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.51 / $84.51 / $255.00
| Professional | | $84.51 | $84.51 | $255.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.16 / $140.81 / $164.78
| Professional | | $106.16 | $140.81 | $164.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.77 / $82.68 / $117.64
| Professional | | $68.77 | $82.68 | $117.64 |