- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.33 / $110.87 / $154.85
| Professional | | $81.33 | $110.87 | $154.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.69 / $515.55 / $611.60
| Facility | | $446.69 | $515.55 | $611.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.69 / $140.99 / $265.87
| Professional | | $131.69 | $140.99 | $265.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.32 / $627.45 / $1,103.03
| Facility | | $193.32 | $627.45 | $1,103.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.86 / $248.18 / $330.00
| Professional | | $146.86 | $248.18 | $330.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.59 / $180.16 / $236.41
| Professional | | $125.59 | $180.16 | $236.41 |