- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.73 / $140.81 / $158.97
| Professional | | $120.73 | $140.81 | $158.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.61 / $109.28 / $176.22
| Professional | | $75.61 | $109.28 | $176.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.53 / $84.51 / $84.51
| Professional | | $82.53 | $84.51 | $84.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.49 / $180.65 / $361.57
| Facility | | $135.49 | $180.65 | $361.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.26 / $94.69 / $289.33
| Professional | | $72.26 | $94.69 | $289.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.77 / $87.83 / $135.49
| Professional | | $68.77 | $87.83 | $135.49 |