- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.02 / $127.36 / $140.94
| Professional | | $107.02 | $127.36 | $140.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.83 / $91.66 / $115.76
| Professional | | $70.83 | $91.66 | $115.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.64 / $531.64 / $531.64
| Facility | | $531.64 | $531.64 | $531.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.60 / $136.76 / $177.57
| Professional | | $107.60 | $136.76 | $177.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.80 / $105.19 / $162.28
| Professional | | $87.80 | $105.19 | $162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.02 / $107.02 / $127.36
| Professional | | $107.02 | $107.02 | $127.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.20 / $120.33 / $160.63
| Professional | | $80.20 | $120.33 | $160.63 |