- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.34 / $94.12 / $104.28
| Professional | | $83.34 | $94.12 | $104.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.54 / $323.95 / $531.69
| Facility | | $234.54 | $323.95 | $531.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.47 / $110.47 / $159.66
| Professional | | $110.47 | $110.47 | $159.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.69 / $139.65 / $193.40
| Professional | | $107.69 | $139.65 | $193.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.65 / $124.47 / $190.94
| Professional | | $96.65 | $124.47 | $190.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.34 / $104.28 / $104.28
| Professional | | $83.34 | $104.28 | $104.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.76 / $130.65 / $200.74
| Professional | | $89.76 | $130.65 | $200.74 |