- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.35 / $121.03 / $132.33
| Professional | | $97.35 | $121.03 | $132.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.78 / $282.41 / $300.89
| Facility | | $240.78 | $282.41 | $300.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.77 / $161.51 / $161.51
| Professional | | $128.77 | $161.51 | $161.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.51 / $306.51 / $306.51
| Facility | | $306.51 | $306.51 | $306.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.97 / $174.70 / $253.53
| Professional | | $136.97 | $174.70 | $253.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.91 / $143.36 / $237.80
| Professional | | $112.91 | $143.36 | $237.80 |