- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.48 / $126.48 / $134.02
| Professional | | $126.48 | $126.48 | $134.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.22 / $304.19 / $499.24
| Facility | | $220.22 | $304.19 | $499.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.26 / $143.26 / $196.41
| Professional | | $143.26 | $143.26 | $196.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.80 / $174.25 / $247.31
| Professional | | $130.80 | $174.25 | $247.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.02 / $149.28 / $280.08
| Professional | | $129.02 | $149.28 | $280.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.48 / $126.48 / $134.02
| Professional | | $126.48 | $126.48 | $134.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.02 / $300.67 / $455.04
| Professional | | $108.02 | $300.67 | $455.04 |